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Asymptomatic versus Symptomatic Patients with Severe Aortic Stenosis

Kanamori, Norio ; Taniguchi, Tomohiko ; Morimoto, Takeshi ; [et al.]

Springer Science and Business Media LLC ; 2018

In: Scientific Reports Vol. 8, No. 1 ( 2018-07-04)

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In: Scientific Reports, Springer Science and Business Media LLC, Vol. 8, No. 1 ( 2018-07-04)

Abstract: It is unknown how much different are the clinical outcomes between asymptomatic and symptomatic patients with severe aortic stenosis (AS). In the CURRENT AS registry enrolling 3,815 consecutive patients with severe AS, we compared the long-term outcomes between 1808 asymptomatic and 1215 symptomatic patients (exertional dyspnea: N = 813, syncope: N = 136, and angina: N = 266) without heart failure (HF) hospitalization. Symptomatic patients had greater AS severity, and more depressed left ventricular function than asymptomatic patients without much difference in other baseline characteristics. During a median follow-up of 3.2 years, aortic valve replacement (AVR) was performed in 62% of symptomatic patients, and 38% of asymptomatic patients. The cumulative 5-year incidences for the primary outcome measure (a composite of aortic valve-related death or HF hospitalization) was higher in symptomatic patients than in asymptomatic patients (32.3% versus 27.6%, P 〈 0.001). After adjusting for AVR and other variables, the greater risk of symptomatic relative to asymptomatic patients for the primary outcome measure was significant (hazard ratio 1.64, 95% confidence interval 1.41–1.96, P 〈 0.001). In conclusions, the excess risk of symptomatic relative to asymptomatic patients with severe AS for the aortic valve-related event was significant. However, the prevalence of AVR in symptomatic patients was not optimal.

Type of Medium: Online Resource

ISSN: 2045-2322

URL: Article

DOI: 10.1038/s41598-018-28162-x

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2018

detail.hit.zdb_id: 2615211-3

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

Nakatsuma, Kenji ; Taniguchi, Tomohiko ; Morimoto, Takeshi ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2017

In: Journal of the American Heart Association Vol. 6, No. 7 ( 2017-07)

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In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 6, No. 7 ( 2017-07)

Abstract: 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 〈 4.5 m/s, N=550; group 2, 4.5 ≤ Vmax 〈 5 m/s, N=279; and group 3, Vmax ≥5 m/s, N=246). Cumulative 5‐year incidence of 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 〈 0.001; symptomatic patients; 55.7%, 60.9%, and 72.2%, 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.

Type of Medium: Online Resource

ISSN: 2047-9980

URL: Article

DOI: 10.1161/JAHA.117.005524

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2017

detail.hit.zdb_id: 2653953-6

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Prognostic Impact of Aortic Valve Area in Conservatively Managed Patients With Asymptomatic Severe Aortic Stenosis With Preserved Ejection Fraction

Kanamori, Norio ; Taniguchi, Tomohiko ; Morimoto, Takeshi ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2019

In: Journal of the American Heart Association Vol. 8, No. 3 ( 2019-02-05)

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In: Journal of the American Heart Association, Ovid Technologies (Wolters Kluwer Health), Vol. 8, No. 3 ( 2019-02-05)

Abstract: See Editorial by Tribouilloy et al

Type of Medium: Online Resource

ISSN: 2047-9980

URL: Article

DOI: 10.1161/JAHA.118.010198

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2019

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Prognostic Impact of Left Ventricular Ejection Fraction in Patients With Severe Aortic Stenosis

Taniguchi, Tomohiko ; Morimoto, Takeshi ; Shiomi, Hiroki ; [et al.]

Elsevier BV ; 2018

In: JACC: Cardiovascular Interventions Vol. 11, No. 2 ( 2018-01), p. 145-157

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In: JACC: Cardiovascular Interventions, Elsevier BV, Vol. 11, No. 2 ( 2018-01), p. 145-157

Type of Medium: Online Resource

ISSN: 1936-8798

URL: Article

DOI: 10.1016/j.jcin.2017.08.036

Language: English

Publisher: Elsevier BV

Publication Date: 2018

detail.hit.zdb_id: 2452163-2

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Anemia in Patients with Severe Aortic Stenosis

Nagao, Kazuya ; Taniguchi, Tomohiko ; Morimoto, Takeshi ; [et al.]

Springer Science and Business Media LLC ; 2019

In: Scientific Reports Vol. 9, No. 1 ( 2019-02-13)

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In: Scientific Reports, Springer Science and Business Media LLC, Vol. 9, No. 1 ( 2019-02-13)

Abstract: Prognostic impact of anemia complicating severe aortic stenosis (AS) remains unclear. We assessed the impact of anemia on cardiovascular and bleeding outcomes in 3403 patients enrolled in the CURRENT AS registry. 835 patients (25%) had mild (hemoglobin 11.0–12.9 g/dl for men/11.0–11.9 g/dl for women) and 1282 patients (38%) had moderate/severe anemia (Hb ≤ 10.9 g/dl) at diagnosis of severe AS. Mild and moderate/severe anemia were associated with significantly increased risks relative to no anemia (hemoglobin ≥13.0 g/dl for men/≥12.0 g/dl for women) for the primary outcome measure (aortic valve-related death or heart failure hospitalization) in the entire population [hazard ratio (HR): 1.30; 95% confidence interval (CI): 1.07–1.57 and HR: 1.56; 95%CI: 1.31–1.87, respectively] and in the conservative management stratum (HR: 1.73; 95%CI: 1.40–2.13 and HR: 2.05; 95%CI: 1.69–2.47, respectively). Even in the initial aortic valve replacement stratum, moderate/severe anemia was associated with significantly increased risk for the primary outcome measure (HR: 2.12; 95%CI: 1.44–3.11). Moreover, moderate/severe anemia was associated with significantly increased risk for major bleeding while under conservative management (HR: 1.93; 95%CI: 1.21–3.06). These results warrant further study to explore whether better management of anemia would lead to improvement of clinical outcomes.

Type of Medium: Online Resource

ISSN: 2045-2322

URL: Article

DOI: 10.1038/s41598-018-36066-z

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2019

detail.hit.zdb_id: 2615211-3

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