PMID- 34864942
OWN - NLM
STAT- MEDLINE
DCOM- 20220603
LR  - 20220824
IS  - 2047-2412 (Electronic)
IS  - 2047-2404 (Linking)
VI  - 23
IP  - 6
DP  - 2022 Jun 1
TI  - Moderate aortic stenosis: importance of symptoms and left ventricular ejection 
      fraction.
PG  - 790-799
LID - 10.1093/ehjci/jeab242 [doi]
AB  - AIMS: The aim of this study is to investigate the independent determinants of 
      survival in patients with moderate aortic stenosis (AS), stratified by severity 
      of symptoms and left ventricular ejection fraction (LVEF). METHODS AND RESULTS: 
      Patients with a first diagnosis of moderate AS (aortic valve area >1.0 and </=1.5 
      cm2) were identified. Patients were stratified by New York Heart Association 
      (NYHA) functional class (NYHA I, NYHA II, or NYHA III-IV) and LVEF (LVEF >/=60%, 
      LVEF 50-59%, or LVEF <50%) at the time of moderate AS diagnosis. The primary 
      endpoint was all-cause mortality, while the secondary endpoint included all-cause 
      mortality and aortic valve replacement. Of 1961 patients with moderate AS (mean 
      age 73 +/- 10 years, 51% men), 1108 (57%) patients were in NYHA class I, while 527 
      (27%) and 326 (17%) patients had symptoms of NYHA class II and III-IV, 
      respectively. Regarding LVEF, 1032 (53%) had LVEF >/=60%, 544 (28%) LVEF 50-59%, 
      and 385 (20%) LVEF <50%. During a median follow-up of 50 (23-82) months, 868 
      (44%) patients died. On multivariable analysis, NYHA class II [hazard ratio (HR): 
      1.633; 95% confidence interval (CI): 1.431-1.864; P < 0.001], NYHA class III-IV 
      (HR: 2.084; 95% CI: 1.797-2.417; P < 0.001), LVEF 50-59% (HR: 1.194; 95% CI: 
      1.013-1.406; P = 0.034), and LVEF <50% (HR: 1.694; 95% CI: 1.417-2.026; P < 
      0.001) were independently associated with increased mortality. CONCLUSION: 
      Moderate AS is associated with poor long-term survival. Baseline symptom severity 
      and LVEF are associated with worse outcomes in these patients. Patients with 
      low-normal LVEF (<60%) and mild symptoms (NYHA II) already have an increased risk 
      of adverse events.
CI  - Published on behalf of the European Society of Cardiology. All rights reserved. (c) 
      The Author(s) 2021. For permissions, please email: journals.permissions@oup.com.
FAU - Stassen, Jan
AU  - Stassen J
AUID- ORCID: 0000-0001-9745-5498
AD  - Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 
      RC Leiden, The Netherlands.
FAU - Ewe, See Hooi
AU  - Ewe SH
AD  - Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, 
      Singapore 169609, Singapore, Singapore.
FAU - Butcher, Steele C
AU  - Butcher SC
AD  - Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 
      RC Leiden, The Netherlands.
AD  - Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA 
      6000, Australia.
FAU - Amanullah, Mohammed R
AU  - Amanullah MR
AD  - Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, 
      Singapore 169609, Singapore, Singapore.
FAU - Hirasawa, Kensuke
AU  - Hirasawa K
AUID- ORCID: 0000-0002-1796-3677
AD  - Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 
      RC Leiden, The Netherlands.
FAU - Singh, Gurpreet K
AU  - Singh GK
AD  - Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 
      RC Leiden, The Netherlands.
FAU - Sin, Kenny Y K
AU  - Sin KYK
AD  - Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, 
      Singapore 169609, Singapore, Singapore.
FAU - Ding, Zee P
AU  - Ding ZP
AD  - Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, 
      Singapore 169609, Singapore, Singapore.
FAU - Pio, Stephan M
AU  - Pio SM
AD  - Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 
      RC Leiden, The Netherlands.
FAU - Sia, Ching-Hui
AU  - Sia CH
AUID- ORCID: 0000-0002-2764-2869
AD  - Department of Cardiology, National University Heart Center Singapore, 5 Lower 
      Kent Ridge Rd, Singapore 119074, Singapore.
FAU - Chew, Nicholas W S
AU  - Chew NWS
AD  - Department of Cardiology, National University Heart Center Singapore, 5 Lower 
      Kent Ridge Rd, Singapore 119074, Singapore.
FAU - Kong, William K F
AU  - Kong WKF
AD  - Department of Cardiology, National University Heart Center Singapore, 5 Lower 
      Kent Ridge Rd, Singapore 119074, Singapore.
FAU - Poh, Kian Keong
AU  - Poh KK
AD  - Department of Cardiology, National University Heart Center Singapore, 5 Lower 
      Kent Ridge Rd, Singapore 119074, Singapore.
FAU - Cohen, David J
AU  - Cohen DJ
AD  - Department of Cardiology, Saint Francis Hospital, 100 Port Washington Blvd, 
      Roslyn, NY 11576, USA.
AD  - Cardiovascular Research Foundation, New York, NY, USA.
FAU - Genereux, Philippe
AU  - Genereux P
AD  - Department of Cardiology, Gagnon Cardiovascular Institute, Morristown Medical 
      Center, 100 Madison Ave, Morristown, NJ 07960, USA.
FAU - Leon, Martin B
AU  - Leon MB
AD  - Department of Cardiology, Columbia University Irving Medical Center/New 
      York-Presbyterian Hospital and Cardiovascular Research Foundation, 622 W 168th 
      St, New York, NY 10032, USA.
FAU - Marsan, Nina Ajmone
AU  - Marsan NA
AD  - Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 
      RC Leiden, The Netherlands.
FAU - Delgado, Victoria
AU  - Delgado V
AUID- ORCID: 0000-0001-7058-3940
AD  - Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 
      RC Leiden, The Netherlands.
FAU - Bax, Jeroen J
AU  - Bax JJ
AD  - Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 
      RC Leiden, The Netherlands.
AD  - Department of Cardiology, Turku Heart Center, University of Turku and Turku 
      University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Eur Heart J Cardiovasc Imaging
JT  - European heart journal. Cardiovascular Imaging
JID - 101573788
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve/diagnostic imaging/surgery
MH  - *Aortic Valve Stenosis/diagnostic imaging/surgery
MH  - Female
MH  - *Heart Valve Prosthesis Implantation/methods
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Stroke Volume
MH  - Treatment Outcome
MH  - *Ventricular Dysfunction, Left/surgery
MH  - Ventricular Function, Left
OTO - NOTNLM
OT  - New York Heart Association functional class
OT  - aortic valve replacement
OT  - left ventricular ejection fraction
OT  - moderate aortic stenosis
OT  - mortality
EDAT- 2021/12/06 06:00
MHDA- 2022/06/07 06:00
CRDT- 2021/12/05 21:39
PHST- 2021/09/29 00:00 [received]
PHST- 2021/11/02 00:00 [accepted]
PHST- 2021/12/06 06:00 [pubmed]
PHST- 2022/06/07 06:00 [medline]
PHST- 2021/12/05 21:39 [entrez]
AID - 6448249 [pii]
AID - 10.1093/ehjci/jeab242 [doi]
PST - ppublish
SO  - Eur Heart J Cardiovasc Imaging. 2022 Jun 1;23(6):790-799. doi: 
      10.1093/ehjci/jeab242.