Clinical InvestigationsAdverse Outcomes in Moderate Aortic StenosisThe Association of Moderate Aortic Stenosis with Poor Survival Is Modified by Age and Left Ventricular Function: Insights from SHEBAHEART Big Data
Section snippets
Study Population
This was a retrospective cohort study of all adult patients (>18 years of age) evaluated at the Sheba Medical Center between 2007 and 2019 who completed echocardiographic evaluations. It is based on the SHEBAHEART big data registry. Sheba Medical Center is the largest hospital in Israel, with 115,000 admissions per year and 22,000 echocardiographic examinations per year. The echocardiography reports together with the electronic medical records of all patients were the sources for this study.
Results
The final study population included 92,622 patients, of whom 2,202 (2.3%) had moderate AS. In addition, there were 438 patients (0.5%) with mild to moderate AS, 1,369 (1.5%) with mild AS, and 88,613 (95.7%) with trivial or no AS. Compared with patients with mild or less AS, those with moderate AS were different with respect to baseline demographic and echocardiographic parameters (Table 1). The final cohort of patients with moderate AS had a median age of 79 years (IQR, 70-85 years) and
Discussion
This analysis offers several important observations. First, it confirms previous data on how moderate AS is associated with poor survival. Second, by using the largest propensity score analysis to date and by censoring patients in whom AS progressed to severe, it suggests that moderate AS is not a marker but an independent predictor of poor survival even when it does not progress to severe AS. Third and most important, it shows how the association of moderate AS with poor survival is modified
Conclusion
Moderate AS is independently associated with poor survival. The associated risk is more pronounced among patients with reduced ejection fraction (<50%) and nonoctogenarian age (<80 years). Our findings underscore the need for careful clinical and echocardiographic follow in this population and support the need for randomized trials to assess the clinical benefit of aortic valve interventions among patients with reduced LVEFs and nonoctogenarian patients.
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Cited by (5)
Prognostic Signals From Moderate Valve Disease in Big Data: An Artefact of Digital Imaging and Communications in Medicine Structured Reporting?
2023, Journal of the American Society of EchocardiographyComments Regarding the Study of Itelman et al. on Moderate Aortic Stenosis and Survival
2022, Journal of the American Society of EchocardiographyTranscatheter Aortic Valve Replacement in Patients with Reduced Ejection Fraction and Nonsevere Aortic Stenosis
2023, Circulation: Cardiovascular Interventions
Drs Itelman and Vatury contributed equally to this work.
Conflicts of interest: None.