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Predictors of Disease Progression and Adverse Clinical Outcomes in Patients With Moderate Aortic Stenosis Using an
Mahmoud Salem1, Hemal Gada1, Basel Ramlawi2
1Heart and Vascular Institute, University of Pittsburgh Medical Center, Harrisburg, Pennsylvania.
Insights
Patients with moderate aortic stenosis (AS) face similar adverse outcomes as severe AS. Atrial fibrillation and end-stage renal disease predict poor outcomes, and one-third progress to severe AS within a year.
Area of Science:
- Cardiology
- Clinical Outcomes Research
- Medical Informatics
Background:
- Moderate aortic stenosis (AS) poses increased clinical risks compared to the general population.
- The comparative risk and progression of moderate AS versus severe AS remain less understood.
- Identifying predictors of adverse outcomes and disease progression in moderate AS is crucial for patient management.
Purpose of the Study:
- To compare adverse clinical outcomes in patients with moderate AS versus severe AS.
- To identify predictors of adverse clinical outcomes and disease progression in moderate AS.
- To evaluate the rate of progression from moderate to severe AS.
Main Methods:
- Analysis of serial echocardiograms (2017-2019) from a large healthcare system.
- AS severity classification based on American Heart Association/American College of Cardiology guidelines.
- Cox proportional hazards models and logistic regression for outcome and progression prediction.
Main Results:
- Patients with moderate AS and severe AS showed similar adverse clinical outcome prevalence, significantly higher than in non-AS patients.
- Atrial fibrillation and end-stage renal disease were significant predictors of adverse outcomes in moderate AS.
- Approximately one-third of moderate AS patients progressed to severe AS within one year.
Conclusions:
- Moderate AS patients experience rapid progression to severe AS and comparable adverse outcomes to severe AS.
- Atrial fibrillation and low ejection fraction are key predictors of adverse events in moderate AS.
- Earlier intervention strategies for moderate AS warrant further investigation, potentially aided by machine learning.
Abstract:
Patients with moderate aortic stenosis (AS) have a greater risk of adverse clinical outcomes than that of the general population. How this risk compares with those with severe AS, along with factors associated with outcomes and disease progression, is less clear. We analyzed serial echoes (from 2017 to 2019) from a single healthcare system using Tempus Next (Chicago, Illinois) software. AS severity was defined according to American Heart Association/American College of Cardiology guidelines. Outcomes of interest included death or heart failure hospitalization. We used Cox proportional hazards models and logistic regression to identify predictors of clinical outcome and disease progression, respectively. From 82,805 echoes for 61,546 patients, 1,770; 914; 565; and 1,463 patients had no, mild, moderate, or severe AS, respectively. Both patients with moderate and those with severe AS experienced a similar prevalence of adverse clinical outcomes (p = 0.45) that was significantly greater than that of patients without AS (p <0.01). In patients with moderate AS, atrial fibrillation (hazard ratio 3.29, 95% confidence interval 1.79 to 6.02, p <0.001) and end-stage renal disease (hazard ratio 3.34, 95% confidence interval 1.87 to 5.95, p <0.001) were associated with adverse clinical outcomes. One-third of patients with moderate AS with a subsequent echo (139/434) progressed to severe AS within 1 year. In conclusion, patients with moderate AS can progress rapidly to severe AS and experience a similar risk of adverse clinical outcomes; predictors include atrial fibrillation and low left ventricular ejection fraction. Machine learning algorithms may help identify these patients. Whether these patients may warrant earlier intervention merits further study.
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