Prognostic factors for progression of early- and late-stage calcific aortic valve disease in Japanese: The Japanese Aortic Stenosis Study (JASS) Retrospective Analysis

Abstract

Calcific aortic valve disease (CAVD) is the most common etiology of acquired valvular heart disease, and hypertension is a principal underlying disease. The Japanese Aortic Stenosis Study (JASS) Retrospective Analysis is a retrospective observational study to clarify the prognostic factors for progression of CAVD in Japanese. Data from 556 subjects who met the following criteria were analyzed: (1) X50 years old; (2) calcification in any aortic valve leaflet or peak aortic jet velocity X2 m s À1 on an echocardiographic study performed between July 2004 and June 2007; and (3) availability of earlier echocardiographic data from within the previous 2-5 years to assess the progression of CAVD. The subjects were divided into two groups according to CAVD severity on the preceding echocardiographic examination. In early-stage subjects with calcification in one or zero leaflets who were without aortic stenosis on the preceding echocardiographic study (n¼157), the prognostic factors for progression were the following: (1) no use of angiotensin receptor blockers (ARB) and (2) use of warfarin. In late-stage subjects with calcification in two or three leaflets and/or aortic stenosis on the preceding echocardiographic study (n¼399), progression was observed in females and in subjects with low hemoglobin and a concentric left ventricle. There was no relation between medications and changes in CAVD. Prognostic factors for the progression of CAVD were different between the early and late stages. Initiation of ARB treatment during the early stage may be effective, and we should be vigilant about progression of CAVD in patients treated with warfarin.

Risk Factors for Progression of Degenerative Aortic Valve Disease in the Japanese – The Japanese Aortic Stenosis Study (JASS) Prospective Analysis –

“…16 ACE, chymase and angiotensin II type 1 receptor are upregulated in the calcified human aortic valve compared with the normal valve, 33,34 suggesting activation of the angiotensin II-angiotensin-receptor axis in DAVD. AS is associated with enhanced inflammatory changes in the aortic valve in the early stage, but with a 'burnt-out' condition in the late stage.…”

“…16 Warfarin attenuates the synthesis and function of matrix γ -carboxyglutamic acid protein, a potent inhibitor of tissue calcification, through its incom- …”

“…16 Therefore, in addition to analysis of all study subjects, subgroup analysis was conducted following the division of 359 subjects into 2 groups according to the degree of DAVD on baseline echocardiography. The group without AS comprised subjects with peak aortic transvalvular flow velocity <2 m/s at baseline (n=150).…”

“…The JASS Retrospective Analysis retrospectively assessed the risk factors with qualitative assessment of DAVD. 16 In the current JASS Prospective Analysis, risk factors were prospectively assessed with quantitative evaluation of DAVD.…”

“…16 In the routine echocardiographic examination, measurements were conducted on-line. Left ventricular mass (LVM) was calculated following a formula derived from data compiled by the American Society of Echocardiography, 18 …”