Abstract:

Background: The prognostic value of cardiac damage staging classification based on the extent of extravalvular damage has been proposed in moderate/severe aortic stenosis (AS).

Objective: To assess the association of cardiac damage staging with mortality across the spectrum of patients with AS following aortic surgical or transcatheter aortic valve replacement (AVR).

Methods: We conducted a pooled meta-analysis of Kaplan-Meier-derived reconstructed time-toevent data of studies published through February 2023.

Results: In total, 16 studies (n=14,499) met our eligibility criteria and included 12,282 patients with symptomatic severe AS and 2,217 patients with asymptomatic severe/moderate AS. For patients with symptomatic severe AS, all-cause mortality was 24.0%, 27.7%, 38.0%, 56.3%, and 57.3% at 5 years in patients with cardiac damage stage 0, 1, 2, 3, and 4, respectively (stage 0 as reference; HR in stage 1: 1.30 [95% CI, 1.03-1.64]; p=0.029; stage 2: 1.74 [95% CI, 1.41-2.16]; p<0.001; stage 3: 2.92 [95% CI, 2.35-3.64]; p<0.001, and stage 4: 3.51 [95% CI, 2.79-4.41]; p<0.001). For patients with asymptomatic moderate/severe AS, all-cause mortality was 19.3%, 36.9%, 51.7%, and 67.8% at 8 years in patients with cardiac damage stage 0, 1, 2, and 3-4, respectively (HR in stage 1: 1.70 [95% CI, 1.21-2.38]; p=0.002; stage 2: 2.20 [95% CI, 1.603.02]; p<0.001; and stage 3-4: 3.90 [95% CI, 2.79-5.47]; p<0.001). Conclusion: In patients undergoing AVR across the symptomatic and severity spectrum of AS, cardiac damage staging at baseline has important prognostic implications. This pooled metaanalysis in patients undergoing AVR suggests that staging of baseline cardiac damage could be considered for timing and selection of therapy in patients with moderate or severe AS to 4 determine the need for earlier AVR or adjunctive pharmacotherapy to prevent irreversible cardiac damage and improve long-term prognosis

JACC: Advances Editor-in-Chief 

Candice K. Silversides, MD, FACC

JACC: Advances CME Editor

Kenneth A. Ellenbogen, MD

Author
Dustin Hillerson, MD, FACC

Important Dates

Date of Release: May 22, 2024 

Term of Approval/Date of CME/MOC Expiration: May 21, 2025