Prognostic implications in patients with symptomatic aortic stenosis and preserved ejection fraction: Japanese multicenter aortic stenosis, retrospective (JUST-R) registry

• Published in: Journal of cardiology Vol. 69; no. 1; pp. 110 - 118
• Main Authors: Izumo, Masaki, MD, Takeuchi, Masaaki, MD, FJCC, Seo, Yoshihiro, MD, FJCC, Yamashita, Eiji, MD, Suzuki, Kengo, MD, FJCC, Ishizu, Tomoko, MD, FJCC, Sato, Kimi, MD, Oshima, Shigeru, MD, FJCC, Aonuma, Kazutaka, MD, FJCC, Otsuji, Yutaka, MD, FJCC, Akashi, Yoshihiro J., MD, FJCC
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.01.2017
• Subjects: Age Factors; Aged; Aortic Valve - surgery; Aortic valve stenosis; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Blood Pressure; Cardiovascular; Chest Pain - epidemiology; Echocardiography; Female; Heart Failure - mortality; Heart Valve Prosthesis Implantation; Humans; Japan - epidemiology; Male; Multivariate Analysis; Prognosis; Registries; Retrospective Studies; Stroke Volume; Syncope; Aortic valve stenosis; Prognosis; Echocardiography
• ISSN: 0914-5087; 1876-4738
• DOI: 10.1016/j.jjcc.2016.01.015

Abstract Background Current prognostic implication of symptomatic patients with aortic stenosis (AS) remains undetermined. This study investigated the current prognostic implications of AS-related symptoms and the effect of aortic valve replacement (AVR) on outcome. Methods We enrolled 586 consecutive patients with severe AS (aortic valve area <1.0 cm2 ) with preserved left ventricular ejection fraction (≥50%). All patients were stratified into the following four groups based on the predominant symptoms: Group 1, asymptomatic ( n = 316); Group 2, chest pain ( n = 41); Group 3, heart failure ( n = 192); or Group 4, syncope ( n = 37). Results AS-related symptoms were diagnosed in 270 patients (46.1%), among whom 182 patients (32.2%) received AVR. Thirty-nine patients (6.7%) had cardiac death during the mean follow-up of 16 ± 14 months. AVR was associated with significant reduction in cardiac death in Groups 3 ( p < 0.001) and 4 ( p = 0.004) whereas no significant prognostic advantage of AVR was observed in Groups 1 or 2. Cox proportional-hazard multivariate analysis revealed that age, heart failure, and mean pressure gradient (PG) were associated with increased risk of cardiac death in all patients regardless of AVR [hazard ratio (HR): 1.079, 2.090, and 1.008 respectively, all p < 0.05]. In the patients without AVR, age, heart failure, syncope, and mean PG were independently associated with cardiac death (HR: 1.130, 3.639, 4.638, and 1.008, all p < 0.05). Conclusion This retrospective study demonstrated the current associations between the types of AS symptoms and prognosis in Japanese patients with severe AS.