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CLINICAL AND ECHOCARDIOGRAPHIC PREDICTORS OF LONG-TERM OUTCOME IN ASYMPTOMATIC PATIENTS WITH SIGNIFICANT AORTIC STENOSIS
A149.E1402 JACC March 9, 2010 Volume 55, issue 10A
VALVULAR HEART DISEASE CLINICAL AND ECHOCARDIOGRAPHIC PREDICTORS OF LONG-TERM OUTCOME IN ASYMPTOMATIC PATIENTS WITH SIGNIFICANT AORTIC STENOSIS ACC Poster Contributions Georgia World Congress Center, Hall B5 Monday, March 15, 2010, 9:30 a.m.-10:30 a.m.
Session Title: Long Term Outcomes in Valvular Disease- Novel Clinical Markers Abstract Category: Valvular Disease Presentation Number: 1171-385 Authors: Duk-Hyun Kang, Jeong-Sook Seo, Byung Joo Sun, Jung Min Ahn, Dae-Hee Kim, Jong-Min Song, Jae-Kwan Song, Hyun Song, Joo Hee Zo, Asan Medical Center, Seoul, South Korea, Boramae Hospital, Seoul, South Korea Background: We tried to identify clinical and echocardiographic predictors of outcome in asymptomatic, moderate to severe aortic stenosis (AS). Methods: From 1997 to 2006, we prospectively enrolled a total of consecutive 492 patients (239 men, age;63±14 yrs) with significant AS, and the exclusion criteria were defined as the presence of symptoms, ejection fraction < 0.50, significant mitral valve disease and aortic valve (AV) replacement within 3 months of enrollment. The severity of AS was classified as moderate, severe, or very severe when the aortic jet velocity was 3.0 to < 4.0, 4.0 to < 5.0 and ≥ 5.0 m/s, respectively. The study endpoint was defined as cardiac death during follow-up. Results: The cause of AS was degenerative in 304 (62%), bicuspid in 112 (23%) and rheumatic in 76 (15%) patients. There were 39 cardiac deaths during median follow-up of 66 months, and the 8-year cardiac mortality-free survival rate was 89±2%. Aortic jet velocity (hazard ratio 2.58, p<0.001), age (hazard ratio 1.06, p<0.001), male gender (hazard ratio 3.56, p<0.001) and diabetes mellitus (hazard ratio 2.23, p=0.045) were independent variables associated with cardiac mortality on Cox multivariate analysis. The 8-year cardiac mortality-free survival rate of very severe AS (69±11%) was significantly lower than those of moderate AS or severe AS (90±2% and 88±4%, respectively, p <0.05 for each). During follow-up, 154 patients required AV replacement due to development of symptoms, and the 8-year survival rate free of cardiac mortality or surgery was 58±3%. Aortic jet velocity (hazard ratio 2.42, p<0.001), moderate to severe AV calcification (hazard ratio 3.90, p=0.003), and bicuspid valve (hazard ratio 1.58, p=0.011) were independent variables predicting late development of cardiac deaths or surgery on Cox multivariate analysis. The 8-year survival rates free of cardiac mortality or surgery were significantly different between moderate (70±3%), severe (34±6%), and very severe AS (18±10%) (p<0.001). Conclusion: The clinical outcomes of very severe AS were significantly worse than those of moderate or severe AS, and the patients with bicuspid AV or moderate to severe AV calcification require more frequent monitoring.
VALVULAR HEART DISEASE CLINICAL AND ECHOCARDIOGRAPHIC PREDICTORS OF LONG-TERM OUTCOME IN ASYMPTOMATIC PATIENTS WITH SIGNIFICANT AORTIC STENOSIS ACC Poster Contributions Georgia World Congress Center, Hall B5 Monday, March 15, 2010, 9:30 a.m.-10:30 a.m.
Session Title: Long Term Outcomes in Valvular Disease- Novel Clinical Markers Abstract Category: Valvular Disease Presentation Number: 1171-385 Authors: Duk-Hyun Kang, Jeong-Sook Seo, Byung Joo Sun, Jung Min Ahn, Dae-Hee Kim, Jong-Min Song, Jae-Kwan Song, Hyun Song, Joo Hee Zo, Asan Medical Center, Seoul, South Korea, Boramae Hospital, Seoul, South Korea Background: We tried to identify clinical and echocardiographic predictors of outcome in asymptomatic, moderate to severe aortic stenosis (AS). Methods: From 1997 to 2006, we prospectively enrolled a total of consecutive 492 patients (239 men, age;63±14 yrs) with significant AS, and the exclusion criteria were defined as the presence of symptoms, ejection fraction < 0.50, significant mitral valve disease and aortic valve (AV) replacement within 3 months of enrollment. The severity of AS was classified as moderate, severe, or very severe when the aortic jet velocity was 3.0 to < 4.0, 4.0 to < 5.0 and ≥ 5.0 m/s, respectively. The study endpoint was defined as cardiac death during follow-up. Results: The cause of AS was degenerative in 304 (62%), bicuspid in 112 (23%) and rheumatic in 76 (15%) patients. There were 39 cardiac deaths during median follow-up of 66 months, and the 8-year cardiac mortality-free survival rate was 89±2%. Aortic jet velocity (hazard ratio 2.58, p<0.001), age (hazard ratio 1.06, p<0.001), male gender (hazard ratio 3.56, p<0.001) and diabetes mellitus (hazard ratio 2.23, p=0.045) were independent variables associated with cardiac mortality on Cox multivariate analysis. The 8-year cardiac mortality-free survival rate of very severe AS (69±11%) was significantly lower than those of moderate AS or severe AS (90±2% and 88±4%, respectively, p <0.05 for each). During follow-up, 154 patients required AV replacement due to development of symptoms, and the 8-year survival rate free of cardiac mortality or surgery was 58±3%. Aortic jet velocity (hazard ratio 2.42, p<0.001), moderate to severe AV calcification (hazard ratio 3.90, p=0.003), and bicuspid valve (hazard ratio 1.58, p=0.011) were independent variables predicting late development of cardiac deaths or surgery on Cox multivariate analysis. The 8-year survival rates free of cardiac mortality or surgery were significantly different between moderate (70±3%), severe (34±6%), and very severe AS (18±10%) (p<0.001). Conclusion: The clinical outcomes of very severe AS were significantly worse than those of moderate or severe AS, and the patients with bicuspid AV or moderate to severe AV calcification require more frequent monitoring.