Prognostic Impact of Peak Aortic Jet Velocity in Conservatively Managed Patients With Severe Aortic Stenosis: An Observation From the CURRENT AS Registry

Autor: Kenji Nakatsuma, Tomohiko Taniguchi, Takeshi Morimoto, Hiroki Shiomi, Kenji Ando, Norio Kanamori, Koichiro Murata, Takeshi Kitai, Yuichi Kawase, Chisato Izumi, Makoto Miyake, Hirokazu Mitsuoka, Masashi Kato, Yutaka Hirano, Shintaro Matsuda, Tsukasa Inada, Kazuya Nagao, Tomoyuki Murakami, Yasuyo Takeuchi, Keiichiro Yamane, Mamoru Toyofuku, Mitsuru Ishii, Eri Minamino‐Muta, Takao Kato, Moriaki Inoko, Tomoyuki Ikeda, Akihiro Komasa, Katsuhisa Ishii, Kozo Hotta, Nobuya Higashitani, Yoshihiro Kato, Yasutaka Inuzuka, Chiyo Maeda, Toshikazu Jinnai, Yuko Morikami, Naritatsu Saito, Kenji Minatoya, Takeshi Kimura, Masao Imai, Junichi Tazaki, Toshiaki Toyota, Hirooki Higami, Tetsuma Kawaji, Shinichi Shirai, Kengo Korai, Takeshi Arita, Shiro Miura, Kyohei Yamaji, Kitae Kim, Keiichiro Iwasaki, Hiroshi Miyawaki, Ayumi Misao, Akimune Kuwayama, Masanobu Ohya, Takenobu Shimada, Hidewo Amano, Masashi Amano, Yusuke Takahashi, Yusuke Yoshikawa, Shunsuke Nishimura, Maiko Kuroda, Tetsu Mizoguchi, Takafumi Yokomatsu, Akihiro Kushiyama, Hidenori Yaku, Toshimitsu Watanabe, Sachiko Sugioka, Naoki Takahashi, Kohei Fukuchi, Hiroshi Mabuchi, Teruki Takeda, Tomoko Sakaguchi, Masayuki Yamaji, Motoyoshi Maenaka, Yutaka Tadano, Makoto Motooka, Ryusuke Nishikawa, Mitsunori Kawato, Minako Kinoshita, Kenji Aida, Kousuke Takahashi, Euihong Ko, Nobutoyo Masunaga, Hisashi Ogawa, Moritake Iguchi, Takashi Unoki, Kensuke Takabayashi, Yasuhiro Hamatani, Yugo Yamashita, Shuhei Tsuji, Soji Nishio, Jyunya Seki, Miho Yamada, Akira Kawamoto, Kouji Sogabe, Michiya Tachiiri, Yukiko Matsumura, Chihiro Ota, Ryuzo Sakata, Kenji Minakata, Michiya Hanyu, Fumio Yamazaki, Tadaaki Koyama, Tatsuhiko Komiya, Kazuo Yamanaka, Noboru Nishiwaki, Motoaki Ohnaka, Hiroaki Osada, Katsuaki Meshii, Toshihiko Saga, Hitoshi Kitayama, Shogo Nakayama, Genichi Sakaguchi, Atsushi Iwakura, Kotaro Shiraga, Koji Ueyama, Keiichi Fujiwara, Atsushi Fukumoto, Senri Miwa, Junichiro Nishizawa, Mitsuru Kitano, Hirotoshi Watanabe, Tomoki Sasa
Rok vydání: 2017
Předmět:
Male
Aortic valve
Time Factors
Hemodynamics
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Severity of Illness Index
Ventricular Function
Left
0302 clinical medicine
Japan
Risk Factors
Registries
030212 general & internal medicine
Original Research
Aged
80 and over
Stroke volume
clinical outcomes
Hospitalization
Treatment Outcome
medicine.anatomical_structure
Aortic Valve
Aortic valve stenosis
Cardiology
Female
Cardiology and Cardiovascular Medicine
peak aortic jet velocity
medicine.medical_specialty
03 medical and health sciences
Internal medicine
Severity of illness
medicine
Humans
Aged
Proportional Hazards Models
Retrospective Studies
Heart Failure
Chi-Square Distribution
business.industry
aortic stenosis
Stroke Volume
Retrospective cohort study
Aortic Valve Stenosis
medicine.disease
Surgery
Stenosis
Valvular Heart Disease
Heart failure
Asymptomatic Diseases
business
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
DOI: 10.1161/jaha.117.005524
Popis: Background There are limited data regarding the risk stratification based on peak aortic jet velocity (Vmax) in patients with severe aortic stenosis ( AS ). Methods and Results Among 3815 consecutive patients with severe AS enrolled in the CURRENT AS (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis) registry, the study population consisted of 1075 conservatively managed patients with Vmax ≥4.0 m/s and left ventricular ejection fraction ≥50%. The study patients were subdivided into 3 groups based on Vmax (group 1, 4.0 ≤ Vmax AS ‐related events (aortic valve–related death or heart failure hospitalization) was incrementally higher with increasing Vmax (entire population; 38.0%, 49.4%, and 62.8%, P P =0.008; and asymptomatic patients; 29.4%, 38.9%, and 47.7%, P =0.005). After adjusting for confounders, the excess risk of group 2 and group 3 relative to group 1 for AS ‐related events remained significant (hazard ratio, 1.39; 95% CI , 1.07–1.81; P =0.02, and hazard ratio, 1.53; 95% CI , 1.17–2.00; P =0.002, respectively). The effect size of group 3 relative to group 1 for AS ‐related events in asymptomatic patients (N=479) was similar to that in symptomatic patients (N=596; hazard ratio, 1.59; 95% CI , 1.01–2.52; P =0.047, and hazard ratio, 1.67; 95% CI , 1.16–2.40, P =0.008, respectively), and there was no significant overall interaction between the symptomatic status and the effect of the Vmax categories on AS ‐related events (interaction, P =0.88). Conclusions In conservatively managed severe AS patients with preserved left ventricular ejection fraction, increasing Vmax was associated with incrementally higher risk for AS ‐related events. However, the cumulative 5‐year incidence of the AS ‐related events remained very high even in asymptomatic patients with less greater Vmax.
Databáze: OpenAIRE
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