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Cardiac Damage in Early Aortic Stenosis: Is the Valve to Blame?
Jordi S Dahl1, Raghav Julakanti1, Mulham Ali1
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Cardiac damage is common in mild aortic stenosis, contrary to previous assumptions. The severity of cardiac damage in mild aortic stenosis is linked to comorbidities, not the degree of stenosis.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Clinical Research
Background:
- Aortic stenosis (AS) is associated with cardiac damage (CD), but its prevalence in mild AS and progression factors are unclear.
- Comorbidities may contribute to CD development alongside altered valvular hemodynamics in AS.
Purpose of the Study:
- To determine the prevalence of cardiac damage (CD) in patients with mild aortic stenosis (AS).
- To identify factors associated with the progression of CD in mild AS.
Main Methods:
- Retrospective study of 9,611 patients with mild AS (peak aortic valve velocity [Vmax] 2-3 m/s) from 2010-2021.
- Cardiac damage (CD) was staged using the Genereux classification.
Main Results:
- Cardiac damage (CD) was highly prevalent, with only 20% of mild AS patients showing no CD (Stage 0).
- CD stage significantly increased with the number of comorbidities, but not with higher Vmax.
- Patients with higher CD stages exhibited a greater burden of comorbidities, including hypertension, heart failure, and diabetes mellitus.
Conclusions:
- Cardiac damage (CD) is highly prevalent in patients with mild aortic stenosis (AS).
- In mild AS, CD severity is strongly associated with the presence of comorbidities, not the degree of stenosis severity.
Background:
Despite the close association between aortic stenosis (AS) and cardiac damage (CD), it is unclear if CD is limited to patients with moderate and severe AS and which factors affect its progression. Although altered valvular hemodynamic status may drive the development of CD in AS, commonly occurring comorbidities may contribute.
Objectives:
The aim of this study was to determine the prevalence of and factors associated with CD in mild AS.
Methods:
This retrospective study included 9,611 patients with mild AS (peak aortic valve velocity [Vmax] 2-3 m/s and description of abnormal aortic valve) from 2010 through 2021. CD was staged using the Genereux classification.
Results:
All but 20% (n = 1,901; stage 0) of patients with mild AS demonstrated CD: 1,613 (17%) stage 1, 4,843 (50%) stage 2, 891 (9%) stage 3, and 363 (4%) stage 4. Patients with higher stages had more comorbidities (hypertension, heart failure, ischemic heart disease, stroke, peripheral arterial disease, chronic kidney disease, chronic pulmonary disease, and diabetes mellitus) but had valvular hemodynamic status similar to those without CD. CD stage did not worsen with higher Vmax range (stage >1 in 64% with Vmax <2.5 m/s vs 61% with Vmax ≥2.5 m/s) but increased with the number of comorbidities, with stage >1 occurring in 50%, 53%, 60%, 66%, 72%, and 73% in the presence of 0, 1, 2, 3, 4, and 5 or more comorbidities, respectively.
Conclusions:
CD was highly prevalent in patients with mild AS. Among patients with mild AS, there was no relationship between the degree of CD and AS severity; instead, CD was highly associated with comorbidities.
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