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

Philippe Généreux1,2,3, Philippe Pibarot4, Björn Redfors1,5

  • 1Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.

European Heart Journal
|October 12, 2017
PubMed

Insights

A new staging system for extravalvular cardiac damage in severe aortic stenosis (AS) predicts mortality after aortic valve replacement (AVR). Increased damage stages correlate with higher mortality risk, improving risk stratification for patients undergoing AVR.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Echocardiography

Background:

  • Risk stratification for aortic valve replacement (AVR) in severe aortic stenosis (AS) traditionally relies on valve-related factors, symptoms, and comorbidities.
  • Extravalvular cardiac damage is increasingly recognized as a significant factor influencing outcomes after AVR.

Purpose of the Study:

  • To evaluate the prognostic impact of a novel staging classification for extravalvular cardiac damage in severe AS patients undergoing AVR.
  • To determine if this staging system improves risk stratification for clinical outcomes post-AVR.

Main Methods:

  • A cohort of 1661 patients with severe AS from the PARTNER 2 trials were retrospectively staged (Stage 0-4) based on echocardiographic evidence of extravalvular cardiac damage prior to AVR.
  • One-year mortality was analyzed using Kaplan-Meier methods and multivariable Cox proportional hazards models.

Main Results:

  • The study identified distinct stages of cardiac damage: Stage 0 (no damage), Stage 1 (left ventricular), Stage 2 (left atrial/mitral), Stage 3 (pulmonary/tricuspid), and Stage 4 (right ventricular).
  • One-year mortality significantly increased with each stage of damage, ranging from 4.4% in Stage 0 to 24.5% in Stage 4 (Ptrend < 0.0001).
  • The extent of cardiac damage was independently associated with increased mortality after AVR (HR 1.46 per stage increment).

Conclusions:

  • A newly described staging classification objectively characterizes the extent of cardiac damage associated with AS.
  • This staging system has significant prognostic implications for predicting clinical outcomes after AVR, offering enhanced risk stratification.
Abstract

Keywords:
Aortic stenosisAortic valveAortic valve replacementClassificationStagingTranscatheter aortic valve implantationTranscatheter aortic valve replacement

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