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The value of evaluating cardiac damage in patients with aortic stenosis: a systematic review and meta-analysis
Sadie Bennett1,2, Eric Holroyd1, Maria F Paton3,4
1Heart and Lung Clinic, University Hospital of North Midlands NHS Trust, Stoke-on-Trent, UK.
Insights
Cardiac damage is prevalent in aortic stenosis (AS) patients, regardless of severity. Increased cardiac damage stages correlate with higher mortality rates, informing decisions about aortic valve replacement (AVR).
Area of Science:
- Cardiology
- Valvular Heart Disease
- Cardiac Physiology
Background:
- Aortic stenosis (AS) is a prevalent valvular heart disease necessitating aortic valve replacement (AVR).
- A novel cardiac damage staging system aids in assessing AS pathophysiological consequences and predicting AVR outcomes.
Purpose of the Study:
- To systematically review the literature on cardiac damage in AS patients.
- To evaluate the association between cardiac damage staging and outcomes such as mortality and major adverse cardiovascular events post-AVR.
Main Methods:
- Systematic review of studies evaluating cardiac damage in AS patients.
- Searches conducted in MEDLINE and EMBASE databases.
- Extraction of data on cardiac damage prevalence, all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events.
Main Results:
- 18 studies with 21,876 patients included; 76-88% of AS patients showed cardiac damage.
- Mortality rates (all-cause and cardiovascular) increased with higher cardiac damage stages.
- Stage 4 cardiac damage significantly increased odds of cardiovascular mortality (OR 6.89) and all-cause mortality (OR 2.94) post-AVR.
Conclusions:
- Cardiac damage is common in AS patients, irrespective of severity or symptoms.
- Increasing cardiac damage stages are linked to elevated mortality.
- Cardiac damage staging may offer prognostic value for AVR timing, especially with left and right ventricular abnormalities.
Background:
Aortic stenosis (AS) is a common valvular heart disease where aortic valve replacement (AVR) is the only treatment. A novel staging system based on cardiac damage was developed to assess the pathophysiological consequence of AS and this has been shown to be associated with outcomes post AVR.
Methods:
We conducted a systematic review of studies which evaluated cardiac damage in patients with AS. A search of MEDLINE and EMBASE was performed with data being extracted from relevant studies. The main outcome of interest were proportion of AS patients with signs of cardiac damage, all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events.
Results:
A total of 18 studies were included with 21,876 patients (mean age 79 years, 52.7% males). Pooled analysis indicated 76% of symptomatic severe AS patients and 88% of asymptomatic moderate/severe AS patients had signs of cardiac damage, with stage two being the most commonly reported (25.1% and 32.3% respectively). For symptomatic severe AS patients, the pooled all-cause mortality and cardiovascular mortality rates increased along an increase in cardiac damage stage from 9.4% to 2.0% respectively for stage 0 to 24.2% and 36.1% respectively for stage 4. In patients with asymptomatic moderate / severe AS, all-cause mortality ranged from 30.0% in stage 0 to 51.2% in stage 3/4. In patients with symptomatic severe AS undergoing AVR, meta-analysis indicated an increase in odds of cardiovascular related mortality for stage 4 cardiac damage only (OR 6.89, 95% CI: 3.04,15.61, p = 0.003). An increased odds of all-cause mortality was seen in for cardiac damage stages 1, 3 and 4 (OR 1.4, 95%CI: 1.10,1.77, p = 0.01, OR 2.27, 95%CI: 1.76,2.92, p = 0.0002 and OR 2.94, 95%CI: 1.97,4.38, p = 0.0006 respectively).
Conclusions:
Cardiac damage is a common finding amongst patients with AS irrespective of AS severity or symptomatic status. Mortality rates appear to increase alongside an increase in cardiac damage staging. Cardiac damage may provide prognostic valve when considering the timing of AVR with left ventricular and right ventricular abnormalities being associated with increased odds of mortality.
Clinical Trial Number:
Not applicable.
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