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Invasive Hemodynamic Staging Classification of Cardiac Damage in Patients With Aortic Stenosis Undergoing Valve

Micha T Maeder1, Lukas Weber1, Daniel Weilenmann1

  • 1Cardiology Division, Kantonsspital, St Gallen, Switzerland.

The Canadian Journal of Cardiology
|May 17, 2020
PubMed

Insights

A new hemodynamic staging system for severe aortic stenosis (AS) predicts mortality after aortic valve replacement (AVR). Advanced stages, particularly pulmonary vascular disease and high right atrial pressure, indicate higher mortality risk.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Hemodynamics

Background:

  • Echocardiography-based cardiac damage classification in aortic stenosis (AS) offers prognostic value.
  • A need exists for a similar classification using invasive hemodynamic data.

Purpose of the Study:

  • To develop a novel 5-stage classification system for cardiac damage in severe AS based on invasive hemodynamics.
  • To assess the prognostic capability of this hemodynamic staging system in predicting mortality after aortic valve replacement (AVR).

Main Methods:

  • Invasive hemodynamic parameters were collected from 421 patients with severe AS before AVR.
  • A 5-stage classification (stage 0-4) was defined based on specific hemodynamic criteria including left-ventricular end-diastolic pressure, pulmonary artery pressures, pulmonary vascular resistance, and right atrial pressure.
  • Patients were assigned to the highest stage met.

Main Results:

  • 16% of patients were stage 0, 27% stage 1, 36% stage 2, 17% stage 3, and 4% stage 4.
  • After a median follow-up of 3.8 years post-AVR, mortality was significantly higher in stage 4 (HR 6.17) and stage 3 (HR 4.17) patients compared to stage 0.
  • No significant difference in mortality was observed between stages 0, 1, and 2.

Conclusions:

  • A hemodynamic staging system effectively predicts mortality in severe AS patients undergoing AVR.
  • Pulmonary vascular disease and elevated right atrial pressure are key determinants of mortality in this patient cohort.
Abstract

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