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Staging classification of aortic stenosis based on the extent of cardiac damage

AIMS: In patients with aortic stenosis (AS), risk stratification for aortic valve replacement (AVR) relies mainly on valve-related factors, symptoms and co-morbidities. We sought to evaluate the prognostic impact of a newly-defined staging classification characterizing the extent of extravalvular (e...

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Autores principales: Généreux, Philippe, Pibarot, Philippe, Redfors, Björn, Mack, Michael J, Makkar, Raj R, Jaber, Wael A, Svensson, Lars G, Kapadia, Samir, Tuzcu, E Murat, Thourani, Vinod H, Babaliaros, Vasilis, Herrmann, Howard C, Szeto, Wilson Y, Cohen, David J, Lindman, Brian R, McAndrew, Thomas, Alu, Maria C, Douglas, Pamela S, Hahn, Rebecca T, Kodali, Susheel K, Smith, Craig R, Miller, D Craig, Webb, John G, Leon, Martin B
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5837727/
https://www.ncbi.nlm.nih.gov/pubmed/29020232
http://dx.doi.org/10.1093/eurheartj/ehx381
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author Généreux, Philippe
Pibarot, Philippe
Redfors, Björn
Mack, Michael J
Makkar, Raj R
Jaber, Wael A
Svensson, Lars G
Kapadia, Samir
Tuzcu, E Murat
Thourani, Vinod H
Babaliaros, Vasilis
Herrmann, Howard C
Szeto, Wilson Y
Cohen, David J
Lindman, Brian R
McAndrew, Thomas
Alu, Maria C
Douglas, Pamela S
Hahn, Rebecca T
Kodali, Susheel K
Smith, Craig R
Miller, D Craig
Webb, John G
Leon, Martin B
author_facet Généreux, Philippe
Pibarot, Philippe
Redfors, Björn
Mack, Michael J
Makkar, Raj R
Jaber, Wael A
Svensson, Lars G
Kapadia, Samir
Tuzcu, E Murat
Thourani, Vinod H
Babaliaros, Vasilis
Herrmann, Howard C
Szeto, Wilson Y
Cohen, David J
Lindman, Brian R
McAndrew, Thomas
Alu, Maria C
Douglas, Pamela S
Hahn, Rebecca T
Kodali, Susheel K
Smith, Craig R
Miller, D Craig
Webb, John G
Leon, Martin B
author_sort Généreux, Philippe
collection PubMed
description AIMS: In patients with aortic stenosis (AS), risk stratification for aortic valve replacement (AVR) relies mainly on valve-related factors, symptoms and co-morbidities. We sought to evaluate the prognostic impact of a newly-defined staging classification characterizing the extent of extravalvular (extra-aortic valve) cardiac damage among patients with severe AS undergoing AVR. METHODS AND RESULTS: Patients with severe AS from the PARTNER 2 trials were pooled and classified according to the presence or absence of cardiac damage as detected by echocardiography prior to AVR: 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). One-year outcomes were compared using Kaplan–Meier techniques and multivariable Cox proportional hazards models were used to identify 1-year predictors of mortality. In 1661 patients with sufficient echocardiographic data to allow staging, 47 (2.8%) patients were classified as Stage 0, 212 (12.8%) as Stage 1, 844 (50.8%) as Stage 2, 413 (24.9%) as Stage 3, and 145 (8.7%) as Stage 4. One-year mortality was 4.4% in Stage 0, 9.2% in Stage 1, 14.4% in Stage 2, 21.3% in Stage 3, and 24.5% in Stage 4 (P(trend) < 0.0001). The extent of cardiac damage was independently associated with increased mortality after AVR (HR 1.46 per each increment in stage, 95% confidence interval 1.27–1.67, P < 0.0001). CONCLUSION: This newly described staging classification objectively characterizes the extent of cardiac damage associated with AS and has important prognostic implications for clinical outcomes after AVR.
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spelling pubmed-58377272018-03-09 Staging classification of aortic stenosis based on the extent of cardiac damage Généreux, Philippe Pibarot, Philippe Redfors, Björn Mack, Michael J Makkar, Raj R Jaber, Wael A Svensson, Lars G Kapadia, Samir Tuzcu, E Murat Thourani, Vinod H Babaliaros, Vasilis Herrmann, Howard C Szeto, Wilson Y Cohen, David J Lindman, Brian R McAndrew, Thomas Alu, Maria C Douglas, Pamela S Hahn, Rebecca T Kodali, Susheel K Smith, Craig R Miller, D Craig Webb, John G Leon, Martin B Eur Heart J Fast Track Clinical Research AIMS: In patients with aortic stenosis (AS), risk stratification for aortic valve replacement (AVR) relies mainly on valve-related factors, symptoms and co-morbidities. We sought to evaluate the prognostic impact of a newly-defined staging classification characterizing the extent of extravalvular (extra-aortic valve) cardiac damage among patients with severe AS undergoing AVR. METHODS AND RESULTS: Patients with severe AS from the PARTNER 2 trials were pooled and classified according to the presence or absence of cardiac damage as detected by echocardiography prior to AVR: 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). One-year outcomes were compared using Kaplan–Meier techniques and multivariable Cox proportional hazards models were used to identify 1-year predictors of mortality. In 1661 patients with sufficient echocardiographic data to allow staging, 47 (2.8%) patients were classified as Stage 0, 212 (12.8%) as Stage 1, 844 (50.8%) as Stage 2, 413 (24.9%) as Stage 3, and 145 (8.7%) as Stage 4. One-year mortality was 4.4% in Stage 0, 9.2% in Stage 1, 14.4% in Stage 2, 21.3% in Stage 3, and 24.5% in Stage 4 (P(trend) < 0.0001). The extent of cardiac damage was independently associated with increased mortality after AVR (HR 1.46 per each increment in stage, 95% confidence interval 1.27–1.67, P < 0.0001). CONCLUSION: This newly described staging classification objectively characterizes the extent of cardiac damage associated with AS and has important prognostic implications for clinical outcomes after AVR. Oxford University Press 2017-12-01 2017-07-21 /pmc/articles/PMC5837727/ /pubmed/29020232 http://dx.doi.org/10.1093/eurheartj/ehx381 Text en © The Author 2017. Published by Oxford University Press on behalf of the European Society of Cardiology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Fast Track Clinical Research
Généreux, Philippe
Pibarot, Philippe
Redfors, Björn
Mack, Michael J
Makkar, Raj R
Jaber, Wael A
Svensson, Lars G
Kapadia, Samir
Tuzcu, E Murat
Thourani, Vinod H
Babaliaros, Vasilis
Herrmann, Howard C
Szeto, Wilson Y
Cohen, David J
Lindman, Brian R
McAndrew, Thomas
Alu, Maria C
Douglas, Pamela S
Hahn, Rebecca T
Kodali, Susheel K
Smith, Craig R
Miller, D Craig
Webb, John G
Leon, Martin B
Staging classification of aortic stenosis based on the extent of cardiac damage
title Staging classification of aortic stenosis based on the extent of cardiac damage
title_full Staging classification of aortic stenosis based on the extent of cardiac damage
title_fullStr Staging classification of aortic stenosis based on the extent of cardiac damage
title_full_unstemmed Staging classification of aortic stenosis based on the extent of cardiac damage
title_short Staging classification of aortic stenosis based on the extent of cardiac damage
title_sort staging classification of aortic stenosis based on the extent of cardiac damage
topic Fast Track Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5837727/
https://www.ncbi.nlm.nih.gov/pubmed/29020232
http://dx.doi.org/10.1093/eurheartj/ehx381
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