P481 PREDICTIVE FACTORS OF CLINICAL OUTCOME IN PATIENTS WITH AORTIC STENOSIS: DATA FROM THE VENETO REGISTER

Abstract

Abstract Background Aortic valve stenosis represents the most relevant valve disease in the Western world, with a mortality rate exceeding 50%. Calcific aortic valve stenosis was once considered a passive process of the valve deposition of calcium salts, but is now considered a cell–mediated disease. The aim of the present study is to search for predictors of mortality, cardiovascular events and valve replacement in patients with aortic stenosis. Materials and Methods A subgroup of 140 patients affected by moderate–severe aortic valve stenosis from the Cardiology departments of the Treviso Hospital and the High Specialization Hospital of Motta di Livenza included in the Veneto Register. For each patient, information relating to deaths, cardiovascular events and valve staging was therefore collected over time. Results The deceased were 36% of which 22.9% without having replaced the valve. The mean follow–up was 24.99±21.72 months. In the follow–up, the deceased were characterized by an older age, a greater frequency of ischemic heart disease, atrial fibrillation and chronic kidney disease (CKD), a worse eGFR, a higher phosphate level. Among the Cox regression biohumoral data, serum phosphate was significantly associated with mortality in the univariate survey, and eGFR values were also always independently significantly associated with mortality. Kaplan Meyer curves also showed significant differences in the risk of CV events over time between groups with eGFR values greater than equal and less than 60 mL/min. Conclusions The results of the study suggest that the pathology appears to be linked to senescence processes and shares a common basis with atherosclerotic pathology, but also appears to be influenced in its evolution by further determinants such as CKD and blood phosphorus values. These considerations prompt us to reflect on the need for studies aimed at understanding the pathogenetic mechanisms of the proven relationship between cardiovascular MACE and phosphorus values, and that between worse renal function and cardiovascular mortality/morbidity. On the other hand, it seems urgent to be able to propose in the near future an internationally shared prognostic score that considers these predictive variables and can help us to better stratify the clinical evolution of aortic stenosis and influencing the surgical timing.