Aortic valve stenosis in community medical practice: determinants of outcome and implications for aortic valve replacement

The Journal of Thoracic and Cardiovascular Surgery
Joseph MaloufMaurice Enriquez-Sarano

Abstract

To define the objective and subjective measures of aortic stenosis (AS) severity linked to survival after diagnosis in community practice. All 360 Olmsted County, Minnesota residents (74 ± 14 years; 44% men) with AS diagnosed from 1988 to 1997 by echocardiography and without life-threatening comorbid conditions were enrolled. The presentation at first diagnosis, outcomes (mortality, heart failure, cardiac surgery), and coherence of guideline-based criteria for severe AS were analyzed. The presentation was challenging. Cardiac symptoms were frequent (59%) and unassociated with the AS severity (all P > .13). Of the patients with severe AS, as determined by a valve area less than 1.0 cm(2), 67% had low gradient AS (≤40 mm Hg). An aortic valve area less than 1.0 cm(2) was the only objective measure independently determining survival (adjusted risk ratio, 1.81; 95% confidence interval [CI], 1.19-2.70; P < .01) and heart failure (adjusted risk ratio, 2.3; 95% CI, 1.3-4.0; P < .01), even in patients with low-gradient AS and/or an ejection fraction of 50% or greater. Excess mortality (vs expected mortality) occurred with an aortic valve area of less than 1.0 cm(2) (risk ratio, 1.78; 95% CI, 1.33-2.35; P < .001) even without symptoms (r...Continue Reading

References

Apr 1, 1990·Journal of the American College of Cardiology·E Braunwald
Apr 1, 1988·European Heart Journal·D Horstkotte, F Loogen
Apr 1, 1988·European Heart Journal·J NormandC Zambartas
May 1, 1996·The Journal of Thoracic and Cardiovascular Surgery·A GehlotR C Daly
Aug 31, 2000·The New England Journal of Medicine·R RosenhekH Baumgartner
Feb 7, 2003·Journal of the American College of Cardiology·Javier BermejoMiguel A García-Fernández
Feb 12, 2004·Clinical Cancer Research : an Official Journal of the American Association for Cancer Research·Michael W Kattan
Apr 12, 2005·European Heart Journal·Paul DasJohn Chambers
Jun 6, 2006·Journal of the American College of Cardiology·Catherine M Otto
Sep 19, 2006·Lancet·Vuyisile T NkomoMaurice Enriquez-Sarano
Nov 28, 2006·The Annals of Thoracic Surgery·Ramdas G PaiPadmini Varadarajan
Dec 25, 2007·European Heart Journal·Jan MinnersNikolaus Jander
Jun 12, 2008·The Journal of Thoracic and Cardiovascular Surgery·Tomislav MihaljevicDelos M Cosgrove
Mar 24, 2009·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Martijn W A van GeldorpAd J J C Bogers

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Citations

May 20, 2014·Progress in Cardiovascular Diseases·Jeremy J ThadenMaurice Enriquez-Sarano
Mar 17, 2015·JACC. Cardiovascular Imaging·Marie-Annick ClavelMaurice Enriquez-Sarano
Mar 17, 2015·JACC. Cardiovascular Imaging·Rebecca T HahnLinda D Gillam
Oct 17, 2015·Current Problems in Cardiology·Sorin V PislaruPatricia A Pellikka
Aug 26, 2014·The Canadian Journal of Cardiology·Marie-Annick ClavelPhilippe Pibarot
May 18, 2016·European Heart Journal·Marie-Annick ClavelPhilippe Pibarot
Sep 23, 2014·Journal of the American College of Cardiology·Marie-Annick ClavelMaurice Enriquez-Sarano
Jun 22, 2015·JACC. Cardiovascular Imaging·Dan RusinaruChristophe Tribouilloy
Mar 25, 2014·Journal of the American College of Cardiology·Marie-Annick ClavelMaurice Enriquez-Sarano
Feb 18, 2014·Journal of the American College of Cardiology·Shahbudin H Rahimtoola
Oct 16, 2012·Journal of the American College of Cardiology·Philippe Pibarot, Jean G Dumesnil
Mar 23, 2015·Current Treatment Options in Cardiovascular Medicine·Katie M Doucet, Ian G Burwash
Jun 8, 2014·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Nassir M ThaljiHartzell V Schaff
Apr 7, 2016·Heart·Romain CapouladePhilippe Pibarot
Oct 8, 2016·Journal of the American College of Cardiology·Martine GilardUNKNOWN FRANCE 2 Investigators
Sep 1, 2017·Heart·Sorin V Pislaru, Patricia A Pellikka
Dec 3, 2016·Circulation. Cardiovascular Imaging·Christophe TribouilloyDan Rusinaru
Jun 11, 2017·Circulation. Cardiovascular Quality and Outcomes·Paolo De SciscioGeoff D Moggridge
Oct 13, 2017·Circulation. Cardiovascular Imaging·Patricia A Pellikka
Jul 9, 2013·Circulation Research·Blase A Carabello
Dec 13, 2012·Circulation. Cardiovascular Imaging·Shivani R AggarwalMaurice Enriquez-Sarano
Apr 7, 2016·Heart·Arturo Evangelista, Laura Galian
Sep 28, 2017·European Heart Journal Cardiovascular Imaging·Giovanni BenfariAndrea Rossi
Feb 5, 2019·Journal of the American Heart Association·Norio KanamoriUNKNOWN CURRENT AS Registry Investigators
Apr 14, 2017·Physiology·Yoginee SritharenJordan D Miller
Jul 22, 2019·Current Cardiology Reports·Qi Liu, Rebecca T Hahn
Sep 12, 2020·The International Journal of Cardiovascular Imaging·Lida KhurramiAxel Cosmus Pyndt Diederichsen
Nov 29, 2020·European Heart Journal Cardiovascular Imaging·Branka VulesevicDavid Messika-Zeitoun
Jul 13, 2021·Circulation. Cardiovascular Imaging·Said AlsidawiVuyisile T Nkomo
Jul 29, 2021·The American Journal of Cardiology·Mika MaedaTakahiro Shiota

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