Clinical InvestigationValvular Heart DiseaseNatural History of Moderate Aortic Stenosis with Preserved and Low Ejection Fraction
Section snippets
Database
Our database includes all patients who underwent echocardiographic examinations (for any indication) at the Tel Aviv Sourasky Medical Center between 2011 and 2016.
In addition to detailed echocardiographic measurements regarding systolic, diastolic, valvular, and right-sided functions and sizes, we also documented extensive clinical details of the patients, including demographics, hospitalization details, background illnesses, and follow-up data regarding invasive interventions and mortality.
Results
In total, our data set comprised 37,037 examinees with data suitable for analysis. Nine hundred fifty-two patients had moderate AS. The average AVA-I and mean pressure gradient for the moderate AS group were 0.71 ± 0.08 cm2/m2 and 20.5 ± 9.3 mm Hg, respectively, and median follow-up time was 181 weeks (IQR, 179–182 weeks).
For the outcome variables of survival under medical management (from diagnosis to surgery or TAVR or death), there were no missing data in the original data set. As for the
Discussion
Our study demonstrates that patients with moderate AS have increased mortality rates compared with control subjects in an unadjusted analysis. These results are similar to those recently presented by researchers in Australia.21 We show that following propensity matching with patients without AS, survival analysis continues to demonstrate a difference in survival. Although several statistically significant differences remain in the propensity-matched groups, the differences are minor and
Conclusion
Patients with moderate AS have increased mortality rates in comparison with matched control subjects. This increased mortality is observed in patients with low or preserved EFs and even in patients with low transaortic gradients.
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Conflicts of interest: None.