Symptoms, disease severity and treatment of adults with a new diagnosis of severe aortic stenosis
ObjectiveContemporary data on patients with previously undiagnosed severe aortic stenosis (AS) are scarce. We aimed to address this gap by gathering data from consecutive patients diagnosed with severe AS on echocardiography.MethodsThis was a prospective, multicentre, multinational, registry in 23 t...
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Published in | Heart (British Cardiac Society) Vol. 105; no. 22; pp. 1709 - 1716 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , |
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Abstract | ObjectiveContemporary data on patients with previously undiagnosed severe aortic stenosis (AS) are scarce. We aimed to address this gap by gathering data from consecutive patients diagnosed with severe AS on echocardiography.MethodsThis was a prospective, multicentre, multinational, registry in 23 tertiary care hospitals across 9 European countries. Patients with a diagnosis of severe AS were included using echocardiography (aortic valve area (AVA) <1 cm2, indexed AVA <0.6 cm2/m2, maximum jet-velocity (Vmax) >4 m/s and/or mean transvalvular gradient >40 mm Hg).ResultsThe 2171 participants had a mean age of 77.9 years and 48.0% were female. The mean AVA was 0.73 cm2, Vmax4.3 m/s and mean gradient 47.1 mm Hg; 62.1% had left ventricular hypertrophy and 27.3% an ejection fraction (EF) <50%. 1743 patients (80.3%) were symptomatic (shortness-of-breath 91.0%; dizziness 30.2%, chest pain 28.9%). Patients had a EuroSCORE II of 4.0; 25.3% had a creatinine clearance <50 mL/min, and 3.2% had an EF <30%. Symptomatic patients were older and had more comorbidities than asymptomatic patients. Despite European Society of Cardiology 2017 valvular heart disease guideline class I recommendation, in only 76.2% a decision was made for an intervention (transcatheter 50.4%, surgical aortic valve replacement 25.8%). In asymptomatic patients, 57.7% with a class I/IIa indication were scheduled for a procedure, while 36.3% patients without an indication had their valve replaced.ConclusionsThe majority of patients with severe AS presented at an advanced disease stage. Management of severe AS remained suboptimal in a significant proportion of contemporary patients with severe AS.Trial registration number NCT02241447;Results. |
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AbstractList | ObjectiveContemporary data on patients with previously undiagnosed severe aortic stenosis (AS) are scarce. We aimed to address this gap by gathering data from consecutive patients diagnosed with severe AS on echocardiography.MethodsThis was a prospective, multicentre, multinational, registry in 23 tertiary care hospitals across 9 European countries. Patients with a diagnosis of severe AS were included using echocardiography (aortic valve area (AVA) <1 cm2, indexed AVA <0.6 cm2/m2, maximum jet-velocity (Vmax) >4 m/s and/or mean transvalvular gradient >40 mm Hg).ResultsThe 2171 participants had a mean age of 77.9 years and 48.0% were female. The mean AVA was 0.73 cm2, Vmax4.3 m/s and mean gradient 47.1 mm Hg; 62.1% had left ventricular hypertrophy and 27.3% an ejection fraction (EF) <50%. 1743 patients (80.3%) were symptomatic (shortness-of-breath 91.0%; dizziness 30.2%, chest pain 28.9%). Patients had a EuroSCORE II of 4.0; 25.3% had a creatinine clearance <50 mL/min, and 3.2% had an EF <30%. Symptomatic patients were older and had more comorbidities than asymptomatic patients. Despite European Society of Cardiology 2017 valvular heart disease guideline class I recommendation, in only 76.2% a decision was made for an intervention (transcatheter 50.4%, surgical aortic valve replacement 25.8%). In asymptomatic patients, 57.7% with a class I/IIa indication were scheduled for a procedure, while 36.3% patients without an indication had their valve replaced.ConclusionsThe majority of patients with severe AS presented at an advanced disease stage. Management of severe AS remained suboptimal in a significant proportion of contemporary patients with severe AS.Trial registration number NCT02241447;Results. OBJECTIVEContemporary data on patients with previously undiagnosed severe aortic stenosis (AS) are scarce. We aimed to address this gap by gathering data from consecutive patients diagnosed with severe AS on echocardiography. METHODSThis was a prospective, multicentre, multinational, registry in 23 tertiary care hospitals across 9 European countries. Patients with a diagnosis of severe AS were included using echocardiography (aortic valve area (AVA) <1 cm2, indexed AVA <0.6 cm2/m2, maximum jet-velocity (Vmax) >4 m/s and/or mean transvalvular gradient >40 mm Hg). RESULTSThe 2171 participants had a mean age of 77.9 years and 48.0% were female. The mean AVA was 0.73 cm2, Vmax4.3 m/s and mean gradient 47.1 mm Hg; 62.1% had left ventricular hypertrophy and 27.3% an ejection fraction (EF) <50%. 1743 patients (80.3%) were symptomatic (shortness-of-breath 91.0%; dizziness 30.2%, chest pain 28.9%). Patients had a EuroSCORE II of 4.0; 25.3% had a creatinine clearance <50 mL/min, and 3.2% had an EF <30%. Symptomatic patients were older and had more comorbidities than asymptomatic patients. Despite European Society of Cardiology 2017 valvular heart disease guideline class I recommendation, in only 76.2% a decision was made for an intervention (transcatheter 50.4%, surgical aortic valve replacement 25.8%). In asymptomatic patients, 57.7% with a class I/IIa indication were scheduled for a procedure, while 36.3% patients without an indication had their valve replaced. CONCLUSIONSThe majority of patients with severe AS presented at an advanced disease stage. Management of severe AS remained suboptimal in a significant proportion of contemporary patients with severe AS. TRIAL REGISTRATION NUMBERNCT02241447;Results. Contemporary data on patients with previously undiagnosed severe aortic stenosis (AS) are scarce. We aimed to address this gap by gathering data from consecutive patients diagnosed with severe AS on echocardiography. This was a prospective, multicentre, multinational, registry in 23 tertiary care hospitals across 9 European countries. Patients with a diagnosis of severe AS were included using echocardiography (aortic valve area (AVA) <1 cm , indexed AVA <0.6 cm /m , maximum jet-velocity (V ) >4 m/s and/or mean transvalvular gradient >40 mm Hg). The 2171 participants had a mean age of 77.9 years and 48.0% were female. The mean AVA was 0.73 cm , V 4.3 m/s and mean gradient 47.1 mm Hg; 62.1% had left ventricular hypertrophy and 27.3% an ejection fraction (EF) <50%. 1743 patients (80.3%) were symptomatic (shortness-of-breath 91.0%; dizziness 30.2%, chest pain 28.9%). Patients had a EuroSCORE II of 4.0; 25.3% had a creatinine clearance <50 mL/min, and 3.2% had an EF <30%. Symptomatic patients were older and had more comorbidities than asymptomatic patients. Despite European Society of Cardiology 2017 valvular heart disease guideline class I recommendation, in only 76.2% a decision was made for an intervention (transcatheter 50.4%, surgical aortic valve replacement 25.8%). In asymptomatic patients, 57.7% with a class I/IIa indication were scheduled for a procedure, while 36.3% patients without an indication had their valve replaced. The majority of patients with severe AS presented at an advanced disease stage. Management of severe AS remained suboptimal in a significant proportion of contemporary patients with severe AS. NCT02241447;Results. |
Author | Serra, Antonio Thambyrajah, Jeetendra Rieber, Johannes Belle, Loic Arnold, Martin Lauten, Alexander Lutz, Matthias Delle Karth, Georg Bouma, Berto J Maly, Jiri Lloyd, Guy Thoenes, Martin Messika-Zeitoun, David Indorfi, Ciro Steeds, Richard Paul Frey, Norbert Clerici, Alberto Kurucova, Jana Schulz, Eberhard Aiello, Marco Pohlmann, Christiane Hauptmann, Karl Eugen Bramlage, Peter Rudolph, Tanja K Bortone, Alessandro Santo Mancone, Massimo |
Author_xml | – sequence: 1 givenname: Norbert surname: Frey fullname: Frey, Norbert email: submission@ippmed.de organization: Department of Cardiology and Angiology, University Medical Center Schleswig-Holstein, Kiel, Germany – sequence: 2 givenname: Richard Paul surname: Steeds fullname: Steeds, Richard Paul email: submission@ippmed.de organization: Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK – sequence: 3 givenname: Tanja K surname: Rudolph fullname: Rudolph, Tanja K email: submission@ippmed.de organization: Heart Centre, University of Cologne, Cologne, Germany – sequence: 4 givenname: Jeetendra surname: Thambyrajah fullname: Thambyrajah, Jeetendra email: submission@ippmed.de organization: Cardiothoracic Division, James Cook Hospital, Middlesbrough, UK – sequence: 5 givenname: Antonio surname: Serra fullname: Serra, Antonio email: submission@ippmed.de organization: Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain – sequence: 6 givenname: Eberhard surname: Schulz fullname: Schulz, Eberhard email: submission@ippmed.de organization: Kardiologie I, Universitätsmedizin der Johannes Gutenberg Universität Mainz, Mainz, Germany – sequence: 7 givenname: Jiri surname: Maly fullname: Maly, Jiri email: submission@ippmed.de organization: Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University, Prague, Czech Republic – sequence: 8 givenname: Marco surname: Aiello fullname: Aiello, Marco email: submission@ippmed.de organization: Cardiothoracic Surgery, Pavia University School of Medicine, Foundation IRCCS Policlinico S.Matteo, Pavia, Italy – sequence: 9 givenname: Guy surname: Lloyd fullname: Lloyd, Guy email: submission@ippmed.de organization: Cardiology/Cardiac Imaging, St Bartholomews Hospital, London, UK – sequence: 10 givenname: Alessandro Santo surname: Bortone fullname: Bortone, Alessandro Santo email: submission@ippmed.de organization: Division of Cardiovascular Surgery, University of Bari, Bari, Italy – sequence: 11 givenname: Karl Eugen surname: Hauptmann fullname: Hauptmann, Karl Eugen email: submission@ippmed.de organization: Abteilung für Innere Medizin , Krankenhaus der Barmherzigen Brüder, Trier, Germany – sequence: 12 givenname: Alberto surname: Clerici fullname: Clerici, Alberto email: submission@ippmed.de organization: Department of Cardiac Surgery, University of Turin, Turin, Italy – sequence: 13 givenname: Georg surname: Delle Karth fullname: Delle Karth, Georg email: submission@ippmed.de organization: Department of Internal Medicine/Cardiology, Hietzing Hospital, Vienna, Austria – sequence: 14 givenname: Johannes surname: Rieber fullname: Rieber, Johannes email: submission@ippmed.de organization: Department of Cardiology and Intensive Care Medicine, Heart Center Bogenhausen, Munich, Germany – sequence: 15 givenname: Ciro surname: Indorfi fullname: Indorfi, Ciro email: submission@ippmed.de organization: Department of Cardiology, Magna Graecia University, Catanzaro, Italy – sequence: 16 givenname: Massimo surname: Mancone fullname: Mancone, Massimo email: submission@ippmed.de organization: Department of Cardiovascular and Respiratory Disease, University of Rome La Sapienza, Rome, Italy – sequence: 17 givenname: Loic surname: Belle fullname: Belle, Loic email: submission@ippmed.de organization: Department of Cardiology, Annecy Hospital, Annecy, France – sequence: 18 givenname: Alexander surname: Lauten fullname: Lauten, Alexander email: submission@ippmed.de organization: Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany – sequence: 19 givenname: Martin surname: Arnold fullname: Arnold, Martin email: submission@ippmed.de organization: Cardiology Department, University of Erlangen, Erlangen, Germany – sequence: 20 givenname: Berto J surname: Bouma fullname: Bouma, Berto J email: submission@ippmed.de organization: AMC Heart Center, Academical Medical Center, University of Amsterdam, Amsterdam, The Netherlands – sequence: 21 givenname: Matthias surname: Lutz fullname: Lutz, Matthias email: submission@ippmed.de organization: Department of Cardiology and Angiology, University Medical Center Schleswig-Holstein, Kiel, Germany – sequence: 22 givenname: Christiane surname: Pohlmann fullname: Pohlmann, Christiane email: submission@ippmed.de organization: Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany – sequence: 23 givenname: Jana surname: Kurucova fullname: Kurucova, Jana email: submission@ippmed.de organization: Edwards Lifesciences, Prague, Czech Republic – sequence: 24 givenname: Martin surname: Thoenes fullname: Thoenes, Martin email: submission@ippmed.de organization: Edwards Lifesciences, Nyon, Switzerland – sequence: 25 givenname: Peter orcidid: 0000-0003-4970-2110 surname: Bramlage fullname: Bramlage, Peter email: submission@ippmed.de organization: Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany – sequence: 26 givenname: David surname: Messika-Zeitoun fullname: Messika-Zeitoun, David email: submission@ippmed.de organization: Heart Institute, University of Ottawa, Ottawa, Canada |
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CitedBy_id | crossref_primary_10_7759_cureus_34973 crossref_primary_10_1007_s15006_019_0928_3 crossref_primary_10_1136_openhrt_2020_001345 crossref_primary_10_1136_openhrt_2020_001443 crossref_primary_10_7759_cureus_29522 crossref_primary_10_1161_JAHA_123_030377 crossref_primary_10_1136_heartjnl_2019_315606 crossref_primary_10_1136_heartjnl_2019_316074 crossref_primary_10_1136_openhrt_2020_001271 crossref_primary_10_1136_heartjnl_2022_321566 crossref_primary_10_1136_openhrt_2021_001640 crossref_primary_10_1136_openhrt_2021_001783 crossref_primary_10_1136_openhrt_2023_002266 crossref_primary_10_1136_openhrt_2020_001485 crossref_primary_10_3390_jcm11174983 |
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Keywords | symptoms transcatheter aortic valve replacement aortic stenosis surgical aortic valve replacement |
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Snippet | ObjectiveContemporary data on patients with previously undiagnosed severe aortic stenosis (AS) are scarce. We aimed to address this gap by gathering data from... Contemporary data on patients with previously undiagnosed severe aortic stenosis (AS) are scarce. We aimed to address this gap by gathering data from... OBJECTIVEContemporary data on patients with previously undiagnosed severe aortic stenosis (AS) are scarce. We aimed to address this gap by gathering data from... |
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SubjectTerms | Activities of daily living Cardiology Cardiovascular disease Ejection fraction Electrocardiography Family medical history Heart Medical prognosis Patients Pulmonary arteries Surgery Thoracic surgery |
Title | Symptoms, disease severity and treatment of adults with a new diagnosis of severe aortic stenosis |
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