Prognostic Impact of Peak Aortic Jet Velocity in Conservatively Managed Patients With Severe Aortic Stenosis: An Observation From the CURRENT AS Registry. Issue 7 (24th July 2017)

• Record Type: Journal Article
• Authors: Nakatsuma, Kenji; Taniguchi, Tomohiko; Morimoto, Takeshi; Shiomi, Hiroki; Ando, Kenji; Kanamori, Norio; Murata, Koichiro; Kitai, Takeshi; Kawase, Yuichi; Izumi, Chisato; Miyake, Makoto; Mitsuoka, Hirokazu; Kato, Masashi; Hirano, Yutaka; Matsuda, Shintaro; Inada, Tsukasa; Nagao, Kazuya; Murakami, Tomoyuki; Takeuchi, Yasuyo; Yamane, Keiichiro; Toyofuku, Mamoru; Ishii, Mitsuru; Minamino‐Muta, Eri; Kato, Takao; Inoko, Moriaki; Ikeda, Tomoyuki; Komasa, Akihiro; Ishii, Katsuhisa; Hotta, Kozo; Higashitani, Nobuya; Kato, Yoshihiro; Inuzuka, Yasutaka; Maeda, Chiyo; Jinnai, Toshikazu; Morikami, Yuko; Saito, Naritatsu; Minatoya, Kenji; Kimura, Takeshi;
• Other Names: Imai Masao investigator.; Tazaki Junichi investigator.; Toyota Toshiaki investigator.; Higami Hirooki investigator.; Kawaji Tetsuma investigator.; Shirai Shinichi investigator.; Korai Kengo investigator.; Arita Takeshi investigator.; Miura Shiro investigator.; Yamaji Kyohei investigator.; Kim Kitae investigator.; Iwasaki Keiichiro investigator.; Miyawaki Hiroshi investigator.; Misao Ayumi investigator.; Kuwayama Akimune investigator.; Ohya Masanobu investigator.; Shimada Takenobu investigator.; Amano Hidewo investigator.; Amano Masashi investigator.; Takahashi Yusuke investigator.; Yoshikawa Yusuke investigator.; Nishimura Shunsuke investigator.; Kuroda Maiko investigator.; Mizoguchi Tetsu investigator.; Yokomatsu Takafumi investigator.; Kushiyama Akihiro investigator.; Yaku Hidenori investigator.; Watanabe Toshimitsu investigator.; Sugioka Sachiko investigator.; Takahashi Naoki investigator.; Fukuchi Kohei investigator.; Mabuchi Hiroshi investigator.; Takeda Teruki investigator.; Sakaguchi Tomoko investigator.; Yamaji Masayuki investigator.; Maenaka Motoyoshi investigator.; Tadano Yutaka investigator.; Motooka Makoto investigator.; Nishikawa Ryusuke investigator.; Kawato Mitsunori investigator.; Kinoshita Minako investigator.; Aida Kenji investigator.; Takahashi Kousuke investigator.; Ko Euihong investigator.; Masunaga Nobutoyo investigator.; Ogawa Hisashi investigator.; Iguchi Moritake investigator.; Unoki Takashi investigator.; Takabayashi Kensuke investigator.; Hamatani Yasuhiro investigator.; Yamashita Yugo investigator.; Tsuji Shuhei investigator.; Nishio Soji investigator.; Seki Jyunya investigator.; Yamada Miho investigator.; Kawamoto Akira investigator.; Sogabe Kouji investigator.; Tachiiri Michiya investigator.; Matsumura Yukiko investigator.; Ota Chihiro investigator.; Sakata Ryuzo investigator.; Minakata Kenji investigator.; Hanyu Michiya investigator.; Yamazaki Fumio investigator.; Koyama Tadaaki investigator.; Komiya Tatsuhiko investigator.; Yamanaka Kazuo investigator.; Nishiwaki Noboru investigator.; Ohnaka Motoaki investigator.; Osada Hiroaki investigator.; Meshii Katsuaki investigator.; Saga Toshihiko investigator.; Kitayama Hitoshi investigator.; Nakayama Shogo investigator.; Sakaguchi Genichi investigator.; Iwakura Atsushi investigator.; Shiraga Kotaro investigator.; Ueyama Koji investigator.; Fujiwara Keiichi investigator.; Fukumoto Atsushi investigator.; Miwa Senri investigator.; Nishizawa Junichiro investigator.; Kitano Mitsuru investigator.; Watanabe Hirotoshi investigator.; Sasa Tomoki investigator.;
• Is Part Of: Journal of the American Heart Association. Volume 6:Issue 7(2017)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2017-07-24
• Subjects: aortic stenosis -- clinical outcomes -- peak aortic jet velocity; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.117.005524
• Languages: English
• ISSNs: 2047-9980

Abstract

Abstract : Background: There are limited data regarding the risk stratification based on peak aortic jet velocity (Vmax) in patients with severe aortic stenosis (AS). Methods and Results: Among 3815 consecutive patients with severe AS enrolled in the CURRENT AS (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis) registry, the study population consisted of 1075 conservatively managed patients with Vmax ≥4.0 m/s and left ventricular ejection fraction ≥50%. The study patients were subdivided into 3 groups based on Vmax (group 1, 4.0 ≤ Vmax <4.5 m/s, N=550; group 2, 4.5 ≤ Vmax <5 m/s, N=279; and group 3, Vmax ≥5 m/s, N=246). Cumulative 5‐year incidence of AS‐related events (aortic valve–related death or heart failure hospitalization) was incrementally higher with increasing Vmax (entire population; 38.0%, 49.4%, and 62.8%, P <0.001; symptomatic patients; 55.7%, 60.9%, and 72.2%, P =0.008; and asymptomatic patients; 29.4%, 38.9%, and 47.7%, P =0.005). After adjusting for confounders, the excess risk of group 2 and group 3 relative to group 1 for AS‐related events remained significant (hazard ratio, 1.39; 95% CI, 1.07–1.81; P =0.02, and hazard ratio, 1.53; 95% CI, 1.17–2.00; P =0.002, respectively). The effect size of group 3 relative to group 1 for AS‐related events in asymptomatic patients (N=479) was similar to that in symptomatic patients (N=596; hazard ratio, 1.59; 95% CI, 1.01–2.52; P =0.047, and hazard ratio, 1.67; 95% CI, 1.16–2.40, P =0.008, respectively), and there was no significant overall interaction between the symptomatic status and the effect of the Vmax categories on AS‐related events (interaction, P =0.88). Conclusions: In conservatively managed severe AS patients with preserved left ventricular ejection fraction, increasing Vmax was associated with incrementally higher risk for AS‐related events. However, the cumulative 5‐year incidence of the AS‐related events remained very high even in asymptomatic patients with less greater Vmax.