Association Between the Degree of Extravalvular Cardiac Damage and the Severity of Aortic Stenosis

Abstract

Background The relationship between the extent of extravalvular cardiac damage (CD) and valve disease severity remains uncertain in aortic stenosis (AS) patients. Objectives The objective of the study was to investigate the correlation between AS severity and CD staging and its clinical impact across the spectrum of AS outpatients. Methods Consecutive patients with mild (peak aortic velocity = 2.5-2.9 m/s), moderate (3-3.9 m/s), and severe AS (≥4 m/s) native AS from a regionwide cohort were included by 117 cardiologists between May 2016 and December 2017 in the VALVENOR cohort. Patients were followed up for 5 years. Results Among the 1,747 patients with available CD (65% of the overall cohort), 744 (42.6%) patients had mild AS, 714 (40.9%) patients moderate AS, and 289 (16.5%) severe AS. Of the 1747 patients, 524 patients (30%) demonstrated CD stage 0, 298 (17%) stage 1, 765 (44%) stage 2, 109 (6%) stage 3, and 51 (3%) stage 4. Patients in stage >0 had higher peak aortic jet velocity compared to patients in stage 0 (3.35 ± 0.69 vs 3.11 ± 0.56 m/s; P < 0.001). After adjustment, higher peak aortic jet velocity (per m/s, P < 0.001) remained independently associated with CD stage >0. Both all-cause mortality and cardiovascular mortality were higher in patients in stage >0 as compared with patients in stage 0 (HR: 1.75; 95% CI: 1.44-2.11; P < 0.001 and HR: 2.52: 95% CI: 1.79-3.55; P < 0.001, respectively). Conclusions The extent of extravalvular CD correlates with AS severity and is associated with poor clinical outcomes across all AS stages. Further research is warranted to determine whether assessing CD should be integrated in the management of patients with AS.