Abstract
Careful auscultation is the first step to diagnose aortic stenosis (AS). The aim of this study was to compare clinical outcomes following transcatheter aortic valve implantation (TAVI) between the patients primarily diagnosed by heart murmur and those diagnosed by other reasons. We retrospectively included 258 patients who underwent TAVI in our medical center, and divided those into the murmur group (n = 81) and the other-reason group (n = 177) according to the primary reason for AS diagnosis. The primary endpoint was the major adverse cardiovascular and cerebrovascular events (MACCE), which was defined as the composite of cardiovascular death, hospitalization due to acute decompensated heart failure, and disabling stroke. The murmur group included younger patients than the other-reason group (82.8 year-old vs. 84.0 year-old, P = 0.02). History of AF was more frequently observed in the other-reason group than in the murmur group (21.5% vs. 7.4%, P <0.01). STS score and logistic EuroSCORE were lower in the murmur group than in the other-reason group (STS: 4.7% vs. 7.2%, P <0.01, logistic EuroSCORE: 8.3% vs. 11.2%, P <0.01). The median follow-up period was 562 days. MACCE was more frequently observed in the other-reason group than in the murmur group (27.7% vs. 9.9%, Log Rank P <0.01). The multivariate COX hazard analysis revealed that the AS patients primarily diagnosed by heart murmur was inversely associated with MACCE (HR 0.38, 95%CI 0.17–0.86, P = 0.020). Among AS patients who underwent TAVI, the patients primarily diagnosed by heart murmur were significantly associated with favorable long-term clinical outcomes.
Highlights
Trans-catheter aortic valve implantation (TAVI) has been a standard therapy for severe aortic valve stenosis (AS), especially in high surgical risk patients [1,2,3,4]
The aim of this study was to compare clinical outcomes following TAVI between the patients primarily diagnosed by heart murmur and the patients diagnosed by other reasons
History of atrial fibrillation (AF) was more frequently observed in the other-reason group than in the murmur group (21.5% vs. 7.4%, P
Summary
Trans-catheter aortic valve implantation (TAVI) has been a standard therapy for severe aortic valve stenosis (AS), especially in high surgical risk patients [1,2,3,4]. Long-term outcomes after TAVI between patients diagnosed by cardiac murmur and other reasons (ADL), or malnutrition have been reported as major predictors of poor long-term outcomes after TAVI [5,6,7,8,9]. It is important to detect severe AS when patients are asymptomatic. Careful auscultation by primary care physician is a key to find asymptomatic patients with severe AS. We hypothesized that severe AS patients primarily diagnosed by heart murmur would have better clinical outcomes as compared to severe AS patients detected by other reasons. The aim of this study was to compare clinical outcomes following TAVI between the patients primarily diagnosed by heart murmur and the patients diagnosed by other reasons
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