PMID- 32204665 OWN - NLM STAT- MEDLINE DCOM- 20210308 LR - 20210308 IS - 2047-9980 (Electronic) IS - 2047-9980 (Linking) VI - 9 IP - 7 DP - 2020 Apr 7 TI - Long-Term Outcomes in Patients With Mixed Aortic Valve Disease and Preserved Left Ventricular Ejection Fraction. PG - e014591 LID - 10.1161/JAHA.119.014591 [doi] LID - e014591 AB - Background Concurrent presence of aortic stenosis and aortic regurgitation is termed mixed aortic valve disease (MAVD). Although multiple articles have addressed patients with "isolated" aortic stenosis or aortic regurgitation, the natural history, impact, and outcomes of MAVD are not well defined. Here, we evaluate long-term outcomes in patients with MAVD and cardiovascular adaptations to chronic MAVD. Methods and Results This observational cohort study evaluated 862 adult patients (56.8% male) with preserved left ventricular ejection fraction and at least moderate aortic regurgitation and moderate aortic stenosis. Primary outcome was all-cause mortality. Subgroup analysis was based on treatment modality (aortic valve replacement [AVR] versus medical management). A regression analysis of longitudinal echocardiographic parameters was performed to assess the natural history of MAVD. Mean age was 68+/-15 years, and mean left ventricular ejection fraction was 58+/-5%. At 4.6 years (25th-75th percentile range, 1.0-8.7), 58.6% of patients underwent an AVR and 48.8% patients died. In both unadjusted and adjusted Cox survival analysis, AVR was associated with improved survival (hazard ratio, 0.41; 95% CI, 0.34-0.51, P<0.001). Impact of AVR persisted when stratifying the cohort by symptom status and baseline aortic valve area (log rank, P<0.001 for both) and after propensity-score matching (hazard ratio, 0.40; 95% CI, 0.32-0.50; P<0.001). In the longitudinal analysis, there were statistically significant changes over time in aortic valve peak gradient (P<0.001) and aortic valve area (P<0.001) and only mild increases in left ventricular end-diastolic (P<0.007) and -systolic (P<0.001) volumes. Conclusions MAVD confers a high risk of all-cause mortality. However, AVR significantly reduces this risk independent of aortic valve area, symptom status, and after controlling for confounding variables. FAU - Isaza, Nicolas AU - Isaza N AD - Department of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. AD - Department of Thoracic and Cardiovascular Surgery Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. FAU - Desai, Milind Y AU - Desai MY AD - Department of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. AD - Department of Thoracic and Cardiovascular Surgery Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. FAU - Kapadia, Samir R AU - Kapadia SR AD - Department of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. AD - Department of Thoracic and Cardiovascular Surgery Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. FAU - Krishnaswamy, Amar AU - Krishnaswamy A AD - Department of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. AD - Department of Thoracic and Cardiovascular Surgery Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. FAU - Rodriguez, L Leonardo AU - Rodriguez LL AD - Department of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. AD - Department of Thoracic and Cardiovascular Surgery Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. FAU - Grimm, Richard A AU - Grimm RA AD - Department of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. AD - Department of Thoracic and Cardiovascular Surgery Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. FAU - Conic, Julijana Z AU - Conic JZ AD - Department of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. AD - Department of Thoracic and Cardiovascular Surgery Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. FAU - Saijo, Yoshihito AU - Saijo Y AD - Department of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. AD - Department of Thoracic and Cardiovascular Surgery Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. FAU - Roselli, Eric E AU - Roselli EE AD - Department of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. AD - Department of Thoracic and Cardiovascular Surgery Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. FAU - Gillinov, A Marc AU - Gillinov AM AD - Department of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. AD - Department of Thoracic and Cardiovascular Surgery Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. FAU - Johnston, Douglas R AU - Johnston DR AD - Department of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. AD - Department of Thoracic and Cardiovascular Surgery Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. FAU - Svensson, Lars G AU - Svensson LG AD - Department of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. AD - Department of Thoracic and Cardiovascular Surgery Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. FAU - Griffin, Brian P AU - Griffin BP AD - Department of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. AD - Department of Thoracic and Cardiovascular Surgery Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. FAU - Popovic, Zoran B AU - Popovic ZB AD - Department of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. AD - Department of Thoracic and Cardiovascular Surgery Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OH. LA - eng PT - Journal Article PT - Observational Study DEP - 20200324 PL - England TA - J Am Heart Assoc JT - Journal of the American Heart Association JID - 101580524 RN - 0 (Cardiovascular Agents) SB - IM MH - Adaptation, Physiological MH - Aged MH - Aged, 80 and over MH - Aortic Valve/diagnostic imaging/*physiopathology/surgery MH - Aortic Valve Insufficiency/diagnostic imaging/mortality/*physiopathology/therapy MH - Aortic Valve Stenosis/diagnostic imaging/mortality/*physiopathology/therapy MH - Cardiovascular Agents/therapeutic use MH - Female MH - Heart Valve Prosthesis Implantation MH - Humans MH - Male MH - Middle Aged MH - Prognosis MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - *Stroke Volume MH - Time Factors MH - *Ventricular Function, Left PMC - PMC7428636 OTO - NOTNLM OT - aortic regurgitation OT - aortic stenosis OT - mixed aortic valve disease OT - survival EDAT- 2020/03/25 06:00 MHDA- 2021/03/09 06:00 PMCR- 2020/04/07 CRDT- 2020/03/25 06:00 PHST- 2020/03/25 06:00 [entrez] PHST- 2020/03/25 06:00 [pubmed] PHST- 2021/03/09 06:00 [medline] PHST- 2020/04/07 00:00 [pmc-release] AID - JAH34890 [pii] AID - 10.1161/JAHA.119.014591 [doi] PST - ppublish SO - J Am Heart Assoc. 2020 Apr 7;9(7):e014591. doi: 10.1161/JAHA.119.014591. Epub 2020 Mar 24.