Cardiac Damage Staging Classification Predicts Prognosis in All the Major Subtypes of Severe Aortic Stenosis: Insights from the National Echo Database Australia

2021 ◽  
Author(s):  
Afik D. Snir ◽  
Martin K. Ng ◽  
Geoff Strange ◽  
David Playford ◽  
Simon Stewart ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Cardiac Damage ◽  
Staging Classification

scholarly journals Serum Biomarkers of Cardiovascular Remodelling Reflect Extra-Valvular Cardiac Damage in Patients with Severe Aortic Stenosis

2020 ◽  
Vol 21 (11) ◽  
pp. 4174
Author(s):  
Laura Bäz ◽  
Gudrun Dannberg ◽  
Katja Grün ◽  
Julian Westphal ◽  
Sven Möbius-Winkler ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Serum Levels ◽  
Serum Biomarkers ◽  
Tissue Remodelling ◽  
Cardiac Damage ◽  
Right Heart ◽  
Cardiovascular Tissue ◽  
Left And Right ◽  
Staging Classification

In patients with aortic stenosis (AS), a novel staging classification of extra-valvular left and right heart damage with prognostic relevance was introduced in 2017. The aim of the study was to evaluate the biomarkers of cardiovascular tissue remodelling in relation to this novel staging classification. Patients were categorized according to the novel staging classification into stages 0 to 4. The levels of matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinases 1 (TIMP-1), B and C domain containing tenascin-C (B+ Tn-C, C+ Tn-C), the ED-A and ED-B domain containing fibronectin (ED-A+ Fn, ED-B+ Fn), endothelin 1 (ET-1) and neutrophil gelatinase-associated lipocalin (NGAL) were determined in serum by ELISA. There were significantly decreased serum levels of MMP-9 and increased levels of B+ Tn-C and C+ Tn-C when comparing stages 0 and 1 with stage 2, with no further dynamics in stages 3 and 4. In contrast, for TIMP-1, C+ Tn-C, ED-A+ Fn, ET-1 and NGAL, significantly increased serum levels could be detected in stages 3 and 4 compared to both stages 0 and 1 and stage 2. ED-A+ Fn and ET-1 could be identified as independent predictors of the presence of stage 3 and/or 4. To the best of our knowledge, this is the first study identifying novel serum biomarkers differentially reflecting the patterns of left and right heart extra-valvular damage in patients suffering from AS. Our findings might indicate a more precise initial diagnosis and risk stratification.

scholarly journals Incremental value of left ventricular global longitudinal strain in a newly proposed staging classification based on cardiac damage in patients with severe aortic stenosis

2020 ◽  
Vol 21 (11) ◽  
pp. 1248-1258 ◽  
Author(s):  
E Mara Vollema ◽  
Mohammed R Amanullah ◽  
Edgard A Prihadi ◽  
Arnold C T Ng ◽  
Pieter van der Bijl ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Damage ◽  
All Cause Mortality ◽  
Incremental Prognostic Value ◽  
Staging Classification

Abstract Aims Cardiac damage in severe aortic stenosis (AS) can be classified according to a recently proposed staging classification. The present study investigated the incremental prognostic value of left ventricular (LV) global longitudinal strain (GLS) over stages of cardiac damage in patients with severe AS. Methods and results From an ongoing registry, a total of 616 severe symptomatic AS patients with available LV GLS by speckle tracking echocardiography were selected and retrospectively analysed. Patients were categorized according to cardiac damage on echocardiography: Stage 0 (no damage), Stage 1 (LV damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage), or Stage 4 (right ventricular damage). LV GLS was divided by quintiles and assigned to the different stages. The endpoint was all-cause mortality. Over a median follow-up of 44 [24–89] months, 234 (38%) patients died. LV GLS was associated with all-cause mortality independent of stage of cardiac damage. After incorporation of LV GLS by quintiles into the staging classification, Stages 2–4 were independently associated with outcome. LV GLS showed incremental prognostic value over clinical characteristics and stages of cardiac damage. Conclusion In this large single-centre cohort of severe AS patients, incorporation of LV GLS by quintiles in a novel proposed staging classification resulted in refinement of risk stratification by identifying patients with more advanced cardiac damage. LV GLS was shown to provide incremental prognostic value over the originally proposed staging classification.

scholarly journals Effect of the Extent of Cardiac Damage on Transcatheter Aortic Valve Replacement Outcome: A New Aortic Stenosis Staging System

2020 ◽  
Vol 13 (2) ◽  
pp. 69-73
Author(s):  
Miho Fukui ◽  
João L Cavalcante
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Staging System ◽  
Cardiac Damage ◽  
Transcatheter Aortic Valve ◽  
Staging Classification

Severe aortic stenosis (AS) causes chronic pressure overload of the left ventricle (LV), resulting in progressive cardiac change that can extend beyond the LV. A new AS staging classification has been recently proposed encompassing the extent of cardiac changes in AS. The AS staging classification has important prognostic implications for clinical outcomes after aortic valve replacement. This article introduces the AS staging system and demonstrates the association of the extent of cardiac change with outcomes after transcatheter aortic valve replacement.

Cardiac Damage Staging Classification and Prognosis in Low Flow Low Gradient Severe Aortic Stenosis

2021 ◽  
Vol 30 ◽  
pp. S178
Author(s):  
A. Snir ◽  
M. Ng ◽  
G. Strange ◽  
D. Playford ◽  
S. Stewart ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Low Flow ◽  
Cardiac Damage ◽  
Staging Classification

Invasive Hemodynamic Staging Classification of Cardiac Damage in Patients With Aortic Stenosis Undergoing Valve Replacement

2020 ◽  
Vol 36 (10) ◽  
pp. 1667-1674 ◽  
Author(s):  
Micha T. Maeder ◽  
Lukas Weber ◽  
Daniel Weilenmann ◽  
Philipp K. Haager ◽  
Lucas Joerg ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Valve Replacement ◽  
Cardiac Damage ◽  
Staging Classification

scholarly journals Impact of Early Surgery and Staging Classification on Survival in Asymptomatic Very Severe Aortic Stenosis

2021 ◽  
Vol 77 (4) ◽  
pp. 506-508
Author(s):  
Sung-Ji Park ◽  
Sahmin Lee ◽  
Seung-Ah Lee ◽  
Dae-Hee Kim ◽  
Hyung-Kwan Kim ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Early Surgery ◽  
Staging Classification

scholarly journals External validation of a new staging system for severe aortic stenosis in a Portuguese cohort

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Silva ◽  
S Maltes ◽  
P Freitas ◽  
A.M Ferreira ◽  
R.C Teles ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Real World ◽  
Cox Regression ◽  
Severe Aortic Stenosis ◽  
Staging System ◽  
Cardiac Damage ◽  
All Cause Mortality ◽  
Stage 1

Abstract Background Recently, a new staging system for severe aortic stenosis (AS) based upon the extent of extra-aortic-valve cardiac damage has been developed (Genereux et al. Eur Heart J 2017). The present study aimed to: 1) determine the prevalence of the different stages of extra-aortic valvular cardiac damage and its impact on prognosis in a real-world Portuguese cohort and; 2) evaluate the distribution of aortic valve calcium score (AV-CaSc) and its prognostic value. Methods Consecutive patients evaluated at a single-centre TAVI-programme between Nov/2015 and Nov/2018 were retrospective selected. The extent of extra-aortic valve cardiac damage was defined by echocardiography as stage 0 (no cardiac damage), stage 1 (left ventricular damage), stage 2 (mitral valve or left atrial damage), stage 3 (tricuspid valve or pulmonary artery vasculature damage) or stage 4 (right ventricular damage). AV-CaSc was estimated routinely at CT-angiography as per TAVI-programme protocol. The primary endpoint was 1-year all-cause mortality after CT-angiography. Survival analysis (Cox-regression hazards model and Kaplan-Meier) was performed. To account for the effect of aortic valve replacement (AVR), this variable entered the Cox-regression model as a time-dependent covariate. Results A total of 443 patients (mean age 82±7 years, 44% men, median euroSCORE II 4% [IQR 2.4–5.8]) were identified. After Heart Team discussion, 79% (n=349) underwent AVR (TAVI=307; surgical valve repair=42); 9% (n=42) await intervention; 6% (n=25) remain under medical treatment; 4% (n=19) died during the period of evaluation; and 2% (n=8) underwent palliative aortic balloon valvuloplasty. According to the proposed classification, the distribution of patients from stages 0 through 4 was: 0.2% (n=1), 7.5% (n=34), 67.8% (n=306), 14% (n=63), and 10.4% (n=47). Additionally, for each increasing stage of cardiac damage, the burden of AV-CaSc was higher (from stage 1 through 4: 1776 [IQR 1217–2448]; 2448 [1796–3442]; 2448 [1832–3622]; 2960 [1936–4878] units; p for trend = 0.002). All-cause mortality at 1-year was 14% (n=63). Mortality increased alongside with increasing extent of cardiac damage (from stage 0 through 4: 0% [n=0], 6% [n=2], 12% [n=36], 20% [n=12], and 30% [n=13]) – Fig. Multivariable analysis revealed chronic renal disease (HR 1.37 per stage [1.15–1.64], p<0.001), AV-CaSc (HR 1.02 per 100 units [1.01–1.03], p=0.007), AVR (HR 0.46 [0.26–0.81], p=0.007) and stage of cardiac damage (HR 1.54 per stage [1.15–2.05], p=0.004) as independent predictors of 1-year mortality. Conclusion In a real-world Portuguese cohort of severe AS patients, the extent of cardiac damage was associated with 1-year mortality. AV- CaSc grants additional prognostic information to this classification. Incorporation of this staging system into patient evaluation may be useful in the risk assessment of severe AS. Survival analysis Funding Acknowledgement Type of funding source: None

P3364Cardiac damage in a real-world severe aortic stenosis population

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Ventura Gomes ◽  
J Pais ◽  
A R Pereira ◽  
D Sebaiti ◽  
I Cruz ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Aortic Stenosis ◽  
Real World ◽  
Primary Outcome ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Damage ◽  
Stage 4 ◽  
Stage 1

Abstract Introduction The cardiac consequences of aortic stenosis, besides left ventricular ejection fraction and systolic pulmonary artery pressure, aren't considered in the recommendations for surgical intervention in patients (pts) with severe aortic stenosis (SAS). In 2017, a new staging echo classification was presented to accurately describe them. Purpose To evaluate this new echo classification in risk stratification of pts with SAS with or without AVR, in a real–world setting. Methods Retrospective cohort study of pts with SAS (mean transvalvular pressure gradient (MG) ≥40 mmHg or a peak transvalvular velocity (PTV) ≥4.0 m/s), examined between January 2014 and December 2016. Pts were classified according to the new staging echo classification (no extravalvular cardiac damage - Stage 0, left ventricular damage - Stage 1, left atrial or mitral valve damage - Stage 2, pulmonary vasculature or tricuspid valve damage - Stage 3, or right ventricular damage - Stage 4). Follow-up (FU) was 2.6±1.0 years. The primary outcome was a composite of cardiovascular death or heart failure hospitalization. Results 212 pts with SAS were included (age 76.1±9.1 years, 31.6% men; aortic valve area 0.69±0.21cm2; PTV 4.5±0.4m/s; MG 48.5±11.6mmHg; LVEF 58.8±12.2%). 19 (9.0%) pts were classified as Stage 0, 29 (13.7%) as Stage 1, 129 (60.8%) as Stage 2, 12 (5.7%) as Stage 3 and 23 (10.8%) as Stage 4. Pts with more advanced stages had more events (stage 0: 5.3%; stage 1: 10.3%; stage 2: 17.1%; stage 3: 50.0%; stage 4: 52.2%; p<0.0001). In the multivariate analysis, the classification system was also a predictor of the outcome, even when including the AVR in the model (table 1). Similar findings in the uni and multivariate analysis were identified when analyzing only the pts with SAS and no aortic intervention (events in stage 0: 16.7%; stage 1: 18.2%; stage 2: 29.3%; stage 3: 75.0%; stage 4: 64.7%, p<0.005; Figure 1). Table 1. Predictors of the outcome Variables Adjusted HR (95% CI) p-value Sex* 1.86 (1.01–3.44) 0.047 eGFR* 0.99 (0.98–1.01) 0.201 AVR* 8.97 (3.85–20.90) 0.0001 Classification* – 0.031   Stage 0 0.19 (0.02–1.537) 0.120   Stage 1 0.28 (0.08–1.01) 0.052   Stage 2 0.36 (0.17–0.74) 0,006   Stage 3 0.81 (0.30–2.19) 0.675   Stage 4 1 – *Variables with p<0.05 in univariate analysis. Figure 1. Survival of SAS pts with no AVR Conclusion In a real-world experience, the new staging echo classification showed a significant relationship between the extent of cardiac damage at baseline and the primary outcome in pts with SAS, even after controlling for AVR. This classification was also able to identify the SAS pts who did not perform AVR and had a significant risk of adverse events.

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