PMID- 11054623
OWN - NLM
STAT- MEDLINE
DCOM- 20001130
LR  - 20191210
IS  - 0002-8703 (Print)
IS  - 0002-8703 (Linking)
VI  - 140
IP  - 5
DP  - 2000 Nov
TI  - Echocardiographic prediction of clinical outcome in medically treated patients 
      with aortic stenosis.
PG  - 766-71
AB  - BACKGROUND: The onset of symptoms is crucial in the natural history of severe 
      aortic stenosis. In contrast, the impact of the degree of valve obstruction and 
      left ventricular dysfunction on clinical outcome in terms of progression of 
      symptoms and mortality is undefined. METHODS AND RESULTS: Between April 1989 and 
      June 1996, 108 patients (75% male, aged 68.7 +/- 10.3 years) with pure and 
      isolated aortic stenosis of at least moderate degree had a complete Doppler 
      echocardiography. Left ventricular end-diastolic and end-systolic diameters, 
      thickness of ventricular septum, mass and ejection fraction, and maximal 
      instantaneous aortic gradient were measured. Patients were followed up through 
      March 1999. Sixty-five patients who underwent aortic valve replacement were 
      censored at the time of surgery. The end point was considered to be death or 
      symptomatic progression (onset of new symptoms or worsening of symptoms). At the 
      time of diagnosis 64 (59%) were in New York Heart Association (NYHA) class I-II 
      and 44 (41%) in NYHA class III-IV. After a mean follow-up of 46 +/- 21 months 6 
      patients died and 45 had worsening of symptoms. Univariate predictors of clinical 
      outcome (death and worsening of symptoms) included left ventricular end-diastolic 
      diameter (hazard ratio 1.03, P =.08), left ventricular end-systolic diameter (HR 
      1.04, P =.012), and left ventricular septum thickness (HR 1.14, P =.009) but not 
      the degree of aortic obstruction. Multivariate predictors of clinical outcome 
      were left ventricular septum thickness (P =.016) and left ventricular 
      end-systolic diameter (P =.008). CONCLUSION: In patients with various degrees of 
      aortic stenosis the rate of clinical outcome is predicted by left ventricular 
      function and septum thickness. Therefore both the left ventricular and aortic 
      valve gradients should be taken into account when choosing the timing of 
      intervention.
FAU - Rossi, A
AU  - Rossi A
AD  - Division of Cardiology, University of Verona, Verona, Italy. 
      arossi@cardiovr.univr.it
FAU - Tomaino, M
AU  - Tomaino M
FAU - Golia, G
AU  - Golia G
FAU - Anselmi, M
AU  - Anselmi M
FAU - Fuca, G
AU  - Fuca G
FAU - Zardini, P
AU  - Zardini P
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
SB  - IM
MH  - Aged
MH  - Analysis of Variance
MH  - Aortic Valve Stenosis/complications/*diagnostic imaging/physiopathology/*therapy
MH  - Confounding Factors, Epidemiologic
MH  - *Echocardiography
MH  - Echocardiography, Doppler
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Severity of Illness Index
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/etiology/*physiopathology
MH  - Ventricular Function, Left
EDAT- 2000/10/31 11:00
MHDA- 2001/02/28 10:01
CRDT- 2000/10/31 11:00
PHST- 2000/10/31 11:00 [pubmed]
PHST- 2001/02/28 10:01 [medline]
PHST- 2000/10/31 11:00 [entrez]
AID - S0002-8703(00)24254-3 [pii]
AID - 10.1067/mhj.2000.111106 [doi]
PST - ppublish
SO  - Am Heart J. 2000 Nov;140(5):766-71. doi: 10.1067/mhj.2000.111106.