TY - JOUR
T1 - Cardiac Damage Staging Classification Predicts Prognosis in All the Major Subtypes of Severe Aortic Stenosis
T2 - Insights from the National Echo Database Australia
AU - Snir, Afik D.
AU - Ng, Martin K.
AU - Strange, Geoff
AU - Playford, David
AU - Stewart, Simon
AU - Celermajer, David S.
AU - National Echo Database of Australia
N1 - Funding Information:
NEDA was originally established with funding support from Actelion Pharmaceuticals, Bayer Pharmaceuticals, and GlaxoSmithKline. Both NEDA (grant 1055214) and Dr. Stewart (grant 11358940) are supported by the National Health and Medical Research Council of Australia. NEDA has received grants from Edwards Lifesciences, but they do not relate to the current report.
Funding Information:
NEDA was originally established with funding support from Actelion Pharmaceuticals , Bayer Pharmaceuticals , and GlaxoSmithKline . Both NEDA (grant 1055214 ) and Dr. Stewart (grant 11358940) are supported by the National Health and Medical Research Council of Australia . NEDA has received grants from Edwards Lifesciences , but they do not relate to the current report.
Publisher Copyright:
© 2021 American Society of Echocardiography
PY - 2021/5/31
Y1 - 2021/5/31
N2 - Background: There are currently no established prognostic models for “low-gradient” severe aortic stenosis (AS), including those with low-flow, low-gradient (LFLG) or normal-flow, low-gradient (NFLG) severe AS. The “cardiac damage staging classification” has been validated as a clinically useful prognostic tool for high-gradient severe AS but not yet for these other common subtypes of severe AS, LFLG and NFLG. Methods: The authors analyzed data from the National Echo Database of Australia, a large national, multicenter registry with individual data linkage to mortality. Of 192,060 adults (mean age, 62.8 ± 17.8 years) with comprehensive ultrasound profiling of the native aortic valve studied between 2000 and 2019, 12,013 (6.3%) had severe AS. On the basis of standard echocardiographic parameters, 5,601 patients with high-gradient, 611 with classical and 959 with paradoxical LFLG, and 911 with NFLG severe AS were identified. Mean follow-up was 88 ± 45 months. All-cause and cardiovascular-related mortality were assessed for each group on an adjusted basis (age and sex) and analyzed by cardiac damage stage. Results: Patients with LFLG AS had greater associated cardiac damage at diagnosis (stages 3 and 4 in 34% of those with classical LFLG, 22.5% of those with paradoxical LFLG, 15.5% of those with NFLG, and 14% of those with high-gradient AS; P < .001). For all four major subtypes of severe AS, there was a progressive increase in 1- and 5-year mortality with increasing cardiac damage score. For example, for paradoxical LFLG severe AS, compared with stage 0 patients, adjusted 1-year all-cause mortality was 22% higher in stage 1 patients, 55% higher in stage 2 patients (P = .095), and 155% higher in stage 3 and 4 patients (P < .001). Among patients with classical LFLG severe AS, compared with stage 1 patients, adjusted 1-year all-cause mortality was 55% higher in stage 2 patients (P = .018) and 100% higher in stage 3 and 4 patients (P < .001). Conclusions: Regardless of severe AS subtype, increasing severity denoted by the cardiac damage staging classification is strongly associated with increasing mortality risk.
AB - Background: There are currently no established prognostic models for “low-gradient” severe aortic stenosis (AS), including those with low-flow, low-gradient (LFLG) or normal-flow, low-gradient (NFLG) severe AS. The “cardiac damage staging classification” has been validated as a clinically useful prognostic tool for high-gradient severe AS but not yet for these other common subtypes of severe AS, LFLG and NFLG. Methods: The authors analyzed data from the National Echo Database of Australia, a large national, multicenter registry with individual data linkage to mortality. Of 192,060 adults (mean age, 62.8 ± 17.8 years) with comprehensive ultrasound profiling of the native aortic valve studied between 2000 and 2019, 12,013 (6.3%) had severe AS. On the basis of standard echocardiographic parameters, 5,601 patients with high-gradient, 611 with classical and 959 with paradoxical LFLG, and 911 with NFLG severe AS were identified. Mean follow-up was 88 ± 45 months. All-cause and cardiovascular-related mortality were assessed for each group on an adjusted basis (age and sex) and analyzed by cardiac damage stage. Results: Patients with LFLG AS had greater associated cardiac damage at diagnosis (stages 3 and 4 in 34% of those with classical LFLG, 22.5% of those with paradoxical LFLG, 15.5% of those with NFLG, and 14% of those with high-gradient AS; P < .001). For all four major subtypes of severe AS, there was a progressive increase in 1- and 5-year mortality with increasing cardiac damage score. For example, for paradoxical LFLG severe AS, compared with stage 0 patients, adjusted 1-year all-cause mortality was 22% higher in stage 1 patients, 55% higher in stage 2 patients (P = .095), and 155% higher in stage 3 and 4 patients (P < .001). Among patients with classical LFLG severe AS, compared with stage 1 patients, adjusted 1-year all-cause mortality was 55% higher in stage 2 patients (P = .018) and 100% higher in stage 3 and 4 patients (P < .001). Conclusions: Regardless of severe AS subtype, increasing severity denoted by the cardiac damage staging classification is strongly associated with increasing mortality risk.
KW - Aortic stenosis prognosis
KW - Cardiac damage staging classification
KW - LFLG aortic stenosis
UR - http://www.scopus.com/inward/record.url?scp=85108540828&partnerID=8YFLogxK
U2 - 10.1016/j.echo.2021.05.017
DO - 10.1016/j.echo.2021.05.017
M3 - Article
C2 - 34082021
AN - SCOPUS:85108540828
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
SN - 0894-7317
ER -