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Cardiac Damage Staging Predicts Outcomes in Aortic Valve Stenosis After Aortic Valve Replacement: Meta-Analysis

Omar M Abdelfattah1, Xander Jacquemyn2, Michel Pompeu Sá3

  • 1Division of Cardiology, University of Texas Medical Branch, Galveston, Texas, USA.

JACC. Advances
|June 28, 2024
PubMed

Insights

Cardiac damage staging predicts mortality in aortic stenosis (AS) patients undergoing aortic valve replacement (AVR). Higher stages correlate with increased all-cause mortality, aiding treatment timing and patient selection for improved prognosis.

Area of Science:

  • Cardiology
  • Cardiovascular Surgery
  • Clinical Prognostics

Background:

  • Aortic stenosis (AS) is a significant cardiovascular condition.
  • Cardiac damage staging, based on extravalvular damage, has been proposed for prognostic assessment in moderate/severe AS.
  • The prognostic value of this staging system requires validation across diverse AS patient populations undergoing intervention.

Purpose of the Study:

  • To evaluate the association between cardiac damage staging and mortality in patients with AS undergoing aortic valve replacement (AVR), either surgically or transcatheter.
  • To assess the prognostic implications of baseline cardiac damage staging across the full spectrum of AS severity and symptoms.

Main Methods:

  • A pooled meta-analysis was performed using reconstructed time-to-event data from Kaplan-Meier curves.
  • Data were sourced from 16 eligible studies published up to February 2023.
  • The analysis included 14,499 patients, comprising 12,282 with symptomatic severe AS and 2,217 with asymptomatic moderate/severe AS.

Main Results:

  • In symptomatic severe AS patients, 5-year all-cause mortality increased significantly with higher cardiac damage stages (Stage 0: 24.0% to Stage 4: 57.3%).
  • Hazard ratios for mortality increased substantially with each stage, e.g., Stage 3 HR 2.92 (P < 0.001) and Stage 4 HR 3.51 (P < 0.001) compared to Stage 0.
  • In asymptomatic moderate/severe AS patients, 8-year all-cause mortality also rose with stage (Stage 0: 19.3% to Stage 3-4: 67.8%), with significant hazard ratios (e.g., Stage 3-4 HR 3.90, P < 0.001).

Conclusions:

  • Baseline cardiac damage staging is a significant prognostic indicator in patients with AS undergoing AVR.
  • This staging system can inform treatment decisions, including the timing of AVR and the need for adjunctive therapies.
  • Utilizing cardiac damage staging may help prevent irreversible damage and improve long-term outcomes for AS patients.
Abstract

Keywords:
aortic stenosisaortic valve replacementcardiac damagetranscatheter aortic valve replacement

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