Poor Long-Term Survival in Patients With Moderate Aortic Stenosis

Strange, Geoff; Stewart, Simon; Celermajer, David S.; Prior, David; Scalia, G.; Marwick, Thomas H.; Ilton, Marcus; Joseph, M.; Codde, Jim; Playford, David

doi:10.1016/j.jacc.2019.08.004

Cited by 293 publications

(236 citation statements)

References 24 publications

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“…Prior surveillance of cardiovascular outcomes in patients with AS were confined mainly to the severe stage of AS. Recently, registry data from National Echocardiographic Database of Australia suggested that even moderate AS is associated with poor long-term survival, the distribution of the risk of mortality among the quartile groups of mean AV gradient is ‘J’ shaped and the pivotal point of increased risk of mortality was a mean AV gradient 18–20 mm Hg 34. Higher mean AV gradient, male sex and age were associated with increased risk of both all-cause and CV-related mortality during long-term follow-up.…”

Section: Introductionmentioning

confidence: 99%

Aortic stenosis in women

Shan

Pellikka

2020

Heart

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Aortic stenosis (AS) is a common valve disorder in an ageing population in western countries, and women, with longer life expectancy, comprise a substantial percentage of elderly patients with AS. Compared with men, women exhibit distinctive characteristics at the level of stenotic valve leaflets and subsequent compensatory responses of the left ventricle to chronic pressure overload, and in clinical presentation, consequences and response to intervention. Randomised controlled trials of transcatheter aortic valve implantation have yielded new evidence of sex differences in both short-term and long-term outcomes after intervention. A comprehensive knowledge of the existing evidence may inform our understanding of gender differences during assessment and treatment of patients with AS. In this paper, we review the available evidence regarding sex differences in AS in terms of symptoms, clinical presentation, anatomical differences and pathophysiological progression, management and outcomes after aortic valve replacement. Implications for further research are suggested.

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Section: Introductionmentioning

confidence: 99%

Aortic stenosis in women

Shan

Pellikka

2020

Heart

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“…Strange and colleagues sought to answer this question using data from the Australian National Echocardiography Database. 8 Out of a total of 122,809 male patients (mean age 61 ± 17 years) and 118,494 female patients (mean age 62 ± 19 years) with measured AV hemodynamics, 16,129 (6.7%), 3,315 (1.4%), and 6,383 (2.6%) patients had mild, moderate, and severe AS, respectively. The median follow-up was 1,208 days.…”

Section: Prognosis For Patients With Moderate Aortic Stenosismentioning

confidence: 97%

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2020

Martin

Weiner

Feinman

et al. 2021

Journal of Cardiothoracic and Vascular Anesthesia

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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“…Moderate HVD encompasses a broad spectrum of patients, ranging from only just more than mild disease to those approaching severe HVD. This needs to be appreciated in the triaging of patients, since patients with moderate-severe aortic stenosis, for example, have an increased risk of events, 8 and so such patients need to be considered as higher risk. Thus, patients with known moderate HVD who were near the cut-offs for severe disease at the last follow-up should be prioritised over patients with stable moderate HVD not near cut-offs for severe HVD.…”

Section: Intermediate Clinical Priority: Moderate Native Valve Diseasementioning

confidence: 99%

Outpatient management of heart valve disease following the COVID-19 pandemic: implications for present and future care

Shah

Schlosshan

McConkey

et al. 2020

Heart

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The established processes for ensuring safe outpatient surveillance of patients with known heart valve disease (HVD), echocardiography for patients referred with new murmurs and timely delivery of surgical or transcatheter treatment for patients with severe disease have all been significantly impacted by the novel coronavirus pandemic. This has created a large backlog of work and upstaging of disease with consequent increases in risk and cost of treatment and potential for worse long-term outcomes. As countries emerge from lockdown but with COVID-19 endemic in society, precautions remain that restrict ‘normal’ practice. In this article, we propose a methodology for restructuring services for patients with HVD and provide recommendations pertaining to frequency of follow-up and use of echocardiography at present. It will be almost impossible to practice exactly as we did prior to the pandemic; thus, it is essential to prioritise patients with the greatest clinical need, such as those with symptomatic severe HVD. Local procedural waiting times will need to be considered, in addition to usual clinical characteristics in determining whether patients requiring intervention would be better suited having surgical or transcatheter treatment. We present guidance on the identification of stable patients with HVD that could have follow-up deferred safely and suggest certain patients that could be discharged from follow-up if waiting lists are triaged with appropriate clinical input. Finally, we propose that novel models of working enforced by the pandemic—such as increased use of virtual clinics—should be further developed and evaluated.

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Poor Long-Term Survival in Patients With Moderate Aortic Stenosis

Cited by 293 publications

References 24 publications

Aortic stenosis in women

Aortic stenosis in women

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2020

Outpatient management of heart valve disease following the COVID-19 pandemic: implications for present and future care

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