TY - JOUR
T1 - Cardiac Damage Staging Predicts Outcomes in Aortic Valve Stenosis After Aortic Valve Replacement
T2 - Meta-Analysis
AU - Abdelfattah, Omar M.
AU - Jacquemyn, Xander
AU - Sá, Michel Pompeu
AU - Jneid, Hani
AU - Sultan, Ibrahim
AU - Cohen, David J.
AU - Gillam, Linda D.
AU - Aron, Lucy
AU - Clavel, Marie Annick
AU - Pibarot, Philippe
AU - Bax, Jeroen J.
AU - Kapadia, Samir R.
AU - Leon, Martin
AU - Généreux, Philippe
N1 - Publisher Copyright:
© 2024 The Authors
PY - 2024/5
Y1 - 2024/5
N2 - BACKGROUND: The prognostic value of cardiac damage staging classification based on the extent of extravalvular damage has been proposed in moderate/severe aortic stenosis (AS).OBJECTIVES: The purpose of this study was to assess the association of cardiac damage staging with mortality across the spectrum of patients with AS following aortic surgical or transcatheter aortic valve replacement (AVR).METHODS: We conducted a pooled meta-analysis of Kaplan-Meier-derived reconstructed time-to-event data from studies published through February 2023.RESULTS: In total, 16 studies (n = 14,499) met our eligibility criteria and included 12,282 patients with symptomatic severe AS and 2,217 patients with asymptomatic severe/moderate AS. For patients with symptomatic severe AS, all-cause mortality was 24.0%, 27.7%, 38.0%, 56.3%, and 57.3% at 5 years in patients with cardiac damage stage 0, 1, 2, 3, and 4, respectively (stage 0 as reference; HR in stage 1: 1.30 [95% CI: 1.03-1.64];
P = 0.029; stage 2: 1.74 [95% CI: 1.41-2.16];
P < 0.001; stage 3: 2.92 [95% CI: 2.35-3.64];
P < 0.001, and stage 4: 3.51 [95% CI: 2.79-4.41];
P < 0.001). For patients with asymptomatic moderate/severe AS, all-cause mortality was 19.3%, 36.9%, 51.7%, and 67.8% at 8 years in patients with cardiac damage stage 0, 1, 2, and 3 to 4, respectively (HR in stage 1: 1.70 [95% CI: 1.21-2.38];
P = 0.002; stage 2: 2.20 [95% CI: 1.60-3.02];
P < 0.001; and stage 3 to 4: 3.90 [95% CI: 2.79-5.47];
P < 0.001).
CONCLUSIONS: In patients undergoing AVR across the symptomatic and severity spectrum of AS, cardiac damage staging at baseline has important prognostic implications. This pooled meta-analysis in patients undergoing AVR suggests that staging of baseline cardiac damage could be considered for timing and selection of therapy in patients with moderate or severe AS to determine the need for earlier AVR or adjunctive pharmacotherapy to prevent irreversible cardiac damage and improve the long-term prognosis.
AB - BACKGROUND: The prognostic value of cardiac damage staging classification based on the extent of extravalvular damage has been proposed in moderate/severe aortic stenosis (AS).OBJECTIVES: The purpose of this study was to assess the association of cardiac damage staging with mortality across the spectrum of patients with AS following aortic surgical or transcatheter aortic valve replacement (AVR).METHODS: We conducted a pooled meta-analysis of Kaplan-Meier-derived reconstructed time-to-event data from studies published through February 2023.RESULTS: In total, 16 studies (n = 14,499) met our eligibility criteria and included 12,282 patients with symptomatic severe AS and 2,217 patients with asymptomatic severe/moderate AS. For patients with symptomatic severe AS, all-cause mortality was 24.0%, 27.7%, 38.0%, 56.3%, and 57.3% at 5 years in patients with cardiac damage stage 0, 1, 2, 3, and 4, respectively (stage 0 as reference; HR in stage 1: 1.30 [95% CI: 1.03-1.64];
P = 0.029; stage 2: 1.74 [95% CI: 1.41-2.16];
P < 0.001; stage 3: 2.92 [95% CI: 2.35-3.64];
P < 0.001, and stage 4: 3.51 [95% CI: 2.79-4.41];
P < 0.001). For patients with asymptomatic moderate/severe AS, all-cause mortality was 19.3%, 36.9%, 51.7%, and 67.8% at 8 years in patients with cardiac damage stage 0, 1, 2, and 3 to 4, respectively (HR in stage 1: 1.70 [95% CI: 1.21-2.38];
P = 0.002; stage 2: 2.20 [95% CI: 1.60-3.02];
P < 0.001; and stage 3 to 4: 3.90 [95% CI: 2.79-5.47];
P < 0.001).
CONCLUSIONS: In patients undergoing AVR across the symptomatic and severity spectrum of AS, cardiac damage staging at baseline has important prognostic implications. This pooled meta-analysis in patients undergoing AVR suggests that staging of baseline cardiac damage could be considered for timing and selection of therapy in patients with moderate or severe AS to determine the need for earlier AVR or adjunctive pharmacotherapy to prevent irreversible cardiac damage and improve the long-term prognosis.
KW - aortic stenosis
KW - aortic valve replacement
KW - cardiac damage
KW - transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85192955576&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85192955576&partnerID=8YFLogxK
U2 - 10.1016/j.jacadv.2024.100959
DO - 10.1016/j.jacadv.2024.100959
M3 - Article
C2 - 38939639
AN - SCOPUS:85192955576
SN - 2772-963X
VL - 3
SP - 100959
JO - JACC: Advances
JF - JACC: Advances
IS - 5
M1 - 100959
ER -