Prevalence Of Severe Aortic Stenosis Research Articles

Implications of methods for calculating the left ventricular outflow tract area in aortic stenosis severity grading

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): - Spanish Ministry of Economy and Competitiveness through the Carlos III Institute of Health-Fondo de Investigación Sanitaria. - Post-residency research contract. Medical Research Institute Hospital La Fe (IIS La Fe), Valencia, Spain. Introduction Aortic valve area (AVA) calculation by continuity equation is a fundamental aspect to estimate aortic stenosis (AS) severity. The estimation of the left ventricular outflow tract (LVOT) area is a source of technical variability in the calculation of AVA that can lead to errors in severity grading. Formulas for calculating LVOT diameter (LVOTd) based on body surface area (BSA) and patient height have been proposed, but their impact on reclassifying patients based on severity has not been described. Purpose To evaluate the differences in AS grading according to the LVOT area used in the calculation of the AVA. Methods We retrospectively analyzed (2019–2022) 1722 echocardiograms with a diagnosis of AS and with the following variables reported: AVA calculated using the continuity equation, height and weight of the patient. Predicted LVOTd by BSA was calculated by the formula: (5.7*BSA + 12). Predicted LVOTd by height was calculated as: (5.78 * height + 12.1). Results LVOT area and AVA from predicted LVOTd based on BSA and height showed slightly higher values. The AVA based on the LVOTd predicted by BSA was associated with a lower prevalence of severe AS, as well as a lower prevalence of discordant cases (mean gradient <40 mmHg and AVA <1 cm2) (Table). The AVA based on both methods of predicted LVOTd led to a reclassification from severe (by the standard method) to non-severe in a significant percentage of patients (13.6% for the BSA-predicted method, and 8.7% for the height-predicted method). For the AVA predicted by BSA, the "downgrade" of AS severity was more frequent (23.3%) in patients in the quartile with the highest BMI (>30 kg/m2), while the degree of obesity did not affect the method predicted by height. Conclusion Despite suppressing the potential errors derived from the LVOTd measurement, the AVA based on predicted LVOTd methods using BSA or height lead to a significant percentage of reclassification in terms of severity and prevalence of discordant severe AS due to low gradient. In obese patients, the method predicted by BSA is highly discordant and the method predicted by the patient's height is preferable.

Hip Fracture Surgery in Severe Aortic Stenosis: A Study of Factors Affecting Mortality.

BackgroundIn elderly patients with hip fracture, the prevalence of severe aortic stenosis (valve area <1 cm2) is close to 5%. Few studies have evaluated the prognostic role of aortic stenosis in hip fracture surgery and none has considered the effects of the postoperative setting (intensive care unit vs general ward) on clinical outcome.PurposeThe aim of the present study was to evaluate the factors affecting mortality in patients with severe aortic stenosis undergoing surgery for hip fracture. We also evaluated whether postoperative monitoring in the intensive care unit may affect the prognosis in comparison to return to the general ward after surgery.Patients and MethodsAll 2274 patients referred for hip fracture to our tertiary teaching hospital between January 1 2015 and December 31 2019 were screened for the presence of severe aortic stenosis, defined by an aortic valve area <1.0 cm2.ResultsThe study included 66 patients (27 males, 39 females) with a mean±SD age of 85±7 years. The average time between trauma and surgery was 2.6±3 days. The mean aortic valve area was 0.74±0.15 cm2. Seven patients died during hospitalization (10.4%). Diabetes, having two or more comorbidities, a low degree of autonomy, heart failure, history of coronary artery disease, atrial fibrillation, postoperative delirium and pulmonary hypertension were associated with poorer outcome. In logistic multivariate analysis, the number of diseases and values of pulmonary artery pressure were the only independent factors related to mortality. In hospital mortality (12 and 9%, respectively) and complication rates were not statistically different between patients referred to the intensive care unit for postoperative monitoring and patients returned to the general ward after surgery.ConclusionIn patients undergoing hip fracture surgery, severe aortic stenosis is associated with high hospital mortality, and two or more comorbidities and pulmonary hypertension are associated with a worse prognosis. The postoperative setting (intensive care unit or general ward) does not affect outcome.

451 Prognostic Impact Of Progression Of Aortic Valve Calcification On The Development Of Aortic Stenosis: Results From The Multi-ethnic Study Of Atherosclerosis (mesa)

Introduction: Aortic stenosis (AS) is the most common primary valve disease in Europe and the United States. The prevalence of severe AS is estimated to be around 1 million by 2025, and survival without valve replacement is about 2-3 years. It is therefore imperative to develop strategies for the early identification and risk stratification of patients with AS. Although valvar calcification is a known intrinsic mechanism leading to AS, the impact of Aortic valve calcium (AVC) progression on the development of AS is unknown

Very acute benefits on physical performance in elderly patients who undergone TAVI

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Transcatheter aortic valve implantation (TAVI) emerged as a safe and efficient procedure in patients with high or prohibitive surgical risk or in older patients. The prevalence of severe aortic stenosis is growing up, given de aging of population. These patients are much often frailty and experience low levels of physical activity and functional capacity as a result of their aortic valve disease and comorbidities. When untreated severe aortic stenosis has a poor prognosis so it is of utmost importance to restore the normal hemodynamic condition and consequently to improve functional capacity. Aim To assess the acute benefits (in 1 moth) of TAVI on functional capacity and physical performance. Methods Single center prospective study of patients submitted to TAVi between April 2021 and September 2021. Patients were evaluated at baseline (before TAVI) and one month after the procedure. To assess physical activity and functional capacity it was used the International Physical Activity Questionnaire (IPAQ) and the short physical performance battery (SPPB) which is a group of measures that combines the results of the gait speed (two timed trials of a 4-m walk – fastest recorded), chair stand (time to raise for a chair 5 times) and balance tests (ability to stand for 10 seconds with feet in 3 different positions). Additionally, patients were submitted to handgrip strength test. Paired sample t-test and Wilcoxon test were used to statistical analysis. Results We included 20 patients, with a mean age of 85±5,86 years, 40% (8) male. 19 patients undergone TAVI due severe native aortic stenosis and 1 due to bioprosthetic aortic valve dysfunction. The vascular access site was transfemoral in 19 patients and transapical in 1 patient. No patient had vigorous physical activity either before or after TAVI, but the daily sitting time was lower after the procedure (mean time: 634 versus 570 minutes), however not statistically significant. Regarding the results of SPPB patients experience improvements in balance (p=0,035) and chair stand (time to raise for a chair 5 times: 19,04 versus 17,05 seconds), p=0,01. Patients tended to be faster in 4m velocity test, however with no statistical difference (8,49 versus 6,6 seconds). No statistical differences were also observed in handgrip strength test. Conclusion In an elderly population, TAVI appears to have an early and beneficial effect (in 1 moth) on some domains oh physical activity and functional capacity.

Is Asymptomatic Severe Aortic Stenosis Still a Waiting Game?

Is Asymptomatic Severe Aortic Stenosis Still a Waiting Game?

Implante transcateter de valva aórtica e marca-passo em feixe de His na vigência de disfunção ventricular esquerda grave e bloqueio de ramo esquerdo

Aortic stenosis is the most prevalent valve disease in developed countries and has high morbidity and mortality after the onset of symptoms. The prevalence of severe aortic stenosis in elderly patients (&gt;75 years) is approximately 3.4%. The transcatheter aortic valve replacement has been employed for approximately 20 years and had robust outcomes published. However, it is a challenging procedure when performed on a patient in cardiogenic shock, caused by severe deterioration of left ventricular function, a condition aggravated in cases of electromechanical dyssynchrony due to left bundle branch block. There is evidence that reestablishing the electrical conduction with a pacemaker implanted directly in the conduction system, in patients with left ventricular dysfunction and dyssynchrony, can significantly improve the systolic function. In this context, the objective of the present study was to present and discuss the particularities and evidence available for treating this complex subgroup of patients.

AORTIC VALVE REPLACEMENT AND OUTCOMES IN PATIENTS WITH SEVERE AORTIC STENOSIS: IS IT BLACK OR WHITE?

Data suggests differences in the incidence and prevalence of severe aortic stenosis (AS) among Caucasian-Americans (CA) and African Americans (AA). Among patients with severe AS there is limited data on the rates of aortic valve replacement (AVR) and mortality as a function of race. Our analysis

The clinical impact of valvular heart disease in a population-based cohort of subjects aged 80 and older

BackgroundIn our ageing society, valvular heart diseases (VHD) have become an increasing public health problem. However, the lack of studies describing the impact of these diseases on the outcome of very old subjects makes it difficult to appreciate their real clinical burden.MethodsProspective, observational, population-based cohort study in Belgium. Five hundred fifty six subjects aged 80 years and older were followed up for 5.1 ± 0.25 years for mortality and 3.0 ± 0.25 years for hospitalization. Echocardiograms were performed at baseline. The Cumulative Illness Rating Scale (CIRS) was calculated for each subject.ResultsThe prevalence of moderate-to-severe VHD was 17 % (n = 97). Mitral stenosis was more prevalent in women and an age-dependent increase of the prevalence of severe aortic stenosis was seen. The overall disease burden was higher in participants with VHD (median CIRS 3 [IQR 3–5] vs 4 [IQR 3–6] (P = 0.008)). Moderate-to-severe VHD, and more specifically mitral stenosis and aortic stenosis, was found to be an independent predictor of both all-cause (HR 1.42 (95 % CI 1.04–1.95)) and cardiovascular mortality (HR 2.13 (95 % CI 1.38–3.29)). Moderate-to-severe VHD was also found to be an independent predictor of the need for a first unplanned hospitalization (HR 1.43 (95 % CI 1.06–1.94)).ConclusionsA high prevalence of moderate-to-severe VHD was found in the very old. Moderate-to-severe VHD was identified as an independent risk factor for all-cause and cardiovascular mortality and as well for unplanned hospitalizations, independent of other structural cardiac abnormalities, ventricular function and major co-morbidities.

Temporal Trends in Disease Severity and Predicted Surgical Risk at the Time of Referral for Echocardiography in Patients Diagnosed with Aortic Stenosis

Calcific aortic stenosis (AS) is the most common underlying pathology in patients undergoing heart valve surgery, with an expected increasing prevalence among the aging population. We identified the temporal trends in referral patterns, disease severity, and associated surgical risk among patients with AS between January 1, 1995 and December 31, 2012 at the Duke University Hospital. A total of 6103 patients had a finding of mild (n = 3303), moderate (n = 1648), or severe AS (n = 1152) in a native aortic valve. Overall presence of severe AS increased significantly over time (P = 0.009) with the most substantial increase occurring from 2010 and onward. Median age upon referral (P < 0.001) and attendant predicted surgical risk (P < 0.001) increased significantly in the observation period among patients with a finding of severe AS. Among patients with a finding of severe AS, the proportion of patients aged older than 80 years increased to 51.0% in the most recent time period (2010-2012) compared with 32.6% in the preceding time period (P < 0.001 for overall time trend). Similarly, the proportion of patients with a logistic EuroSCORE greater than 20% increased to 21.3% (2010-2012) from 12.1% (pre-2010). Among patients referred for echocardiography to a high-volume tertiary hospital center, a significant increase in the prevalence of severe AS was observed over time. This trend occurred in parallel with increasing age and predicted surgical risk at referral. Health-care resource planning should account for an increasing number of patients in need of high-risk aortic valve replacements in the near future.

Racial differences in the prevalence of severe aortic stenosis.

BackgroundIn an era of expanded treatment options for severe aortic stenosis, it is important to understand risk factors for the condition. It has been suggested that severe aortic stenosis is less common in African Americans, but there are limited data from large studies.Methods and ResultsThe Synthetic Derivative at Vanderbilt University Medical Center, a database of over 2.1 million de‐identified patient records, was used to identify individuals who had undergone echocardiography. The association of race with severe aortic stenosis was examined using multivariable logistic regression analyses adjusting for conventional risk factors. Of the 272 429 eligible patients (mean age 45 years, 44% male) with echocardiography, 14% were African American and 82% were Caucasian. Severe aortic stenosis was identified in 106 (0.29%) African‐American patients and 2030 (0.91%) Caucasian patients (crude OR 0.32, 95% CI [0.26, 0.38]). This difference persisted in multivariable‐adjusted analyses (OR 0.41 [0.33, 0.50], P<0.0001). African‐American individuals were also less likely to have severe aortic stenosis due to degenerative calcific disease (adjusted OR 0.47 [0.36, 0.61]) or congenitally bicuspid valve (crude OR 0.13 [0.02, 0.80], adjusted OR dependent on age). Referral bias against those with severe valvular disease was assessed by comparing the prevalence of severe mitral regurgitation in Caucasians and African Americans and no difference was found.ConclusionsThese findings suggest that African Americans are at significantly lower risk of developing severe aortic stenosis than Caucasians.

Indexing aortic valve area by body surface area increases the prevalence of severe aortic stenosis

BackgroundTo account for differences in body size in patients with aortic stenosis, aortic valve area (AVA) is divided by body surface area (BSA) to calculate indexed AVA (AVAindex). Cut-off values...

Aortic Stenosis in the Elderly: Disease Prevalence and Number of Candidates for Transcatheter Aortic Valve Replacement: A Meta-Analysis and Modeling Study

The purpose of this study was to evaluate the prevalence of aortic stenosis (AS) in the elderly and to estimate the current and future number of candidates for transcatheter aortic valve replacement (TAVR). Severe AS is a major cause of morbidity and mortality in the elderly. A proportion of these patients is at high or prohibitive risk for surgical aortic valve replacement, and is now considered for TAVR. A systematic search was conducted in multiple databases, and prevalence rates of patients (>75 years) were pooled. A model was based on a second systematic literature search of studies on decision making in AS. Monte Carlo simulations were performed to estimate the number of TAVR candidates in 19 European countries and North America. Data from 7 studies (n = 9,723 subjects) were used. The pooled prevalence of all AS in the elderly was 12.4% (95% confidence interval [CI]: 6.6% to 18.2%), and the prevalence of severe AS was 3.4% (95% CI: 1.1% to 5.7%). Among elderly patients with severe AS, 75.6% (95% CI: 65.8% to 85.4%) were symptomatic, and 40.5% (95% CI: 35.8% to 45.1%) of these patients were not treated surgically. Of those, 40.3% (95% CI: 33.8% to 46.7%) received TAVR. Of the high-risk patients, 5.2% were TAVR candidates. Projections showed that there are approximately 189,836 (95% CI: 80,281 to 347,372) TAVR candidates in the European countries and 102,558 (95% CI: 43,612 to 187,002) in North America. Annually, there are 17,712 (95% CI: 7,590 to 32,691) new TAVR candidates in the European countries and 9,189 (95% CI: 3,898 to 16,682) in North America. With a pooled prevalence of 3.4%, the burden of disease among the elderly due to severe AS is substantial. Under the current indications, approximately 290,000 elderly patients with severe AS are TAVR candidates. Nearly 27,000 patients become eligible for TAVR annually.

Prevalence of degenerative aortic valve stenosis in the elderly: results of a large community-based epidemiological study

There is a paucity of epidemiological data on the prevalence of degenerative aortic stenosis (AS) after the recent demographic changes and in the present therapeutic era. We sought to assess the prevalence of AS in an elderly population of an Italian urban area and to derive an epidemiological estimate of AS prevalence on a larger scale. Elderly people (aged 75-95 years) of a 26 000 inhabitants town were clinically screened by general practitioners and classified into four groups: (1) no signs of AS; (2) known AS; (3) suspected AS (on the basis of the presence of a systolic murmur); (4) prior aortic valve replacement (AVR). Group 2 and 3 patients underwent physical examination and transthoracic echocardiography to confirm or rule out the diagnosis of AS, and to assess main comorbidities. Among the eligible patients, 2203 (93.7%) had no sign of AS; 49 (2.1%) had known AS; in 74 (3.1%) there was a systolic murmur suggesting AS, and 26 (1.1%) had previous AVR because of AS. Ten patients refused further screening, therefore 113 patients underwent transthoracic echocardiography. Among them, degenerative aortic disease without stenosis was observed in 22, and 63 had confirmed AS (severe in 21). Important comorbidities were frequently diagnosed in these patients. Including patients with previous AVR, AS was confirmed in 89/2350 patients (3.8%). On a regional scale, based on the demographics of this area, we estimated a prevalence of severe AS of 2248 cases per million inhabitants. The prevalence of AS in a population aged 75-95 years was 3.8%, and it was not previously diagnosed in a sizable proportion. More attention for early diagnosis of AS in the elderly is warranted.

TCT-832 Epidemiology of Severe Aortic Stenosis in the Elderly: A Systematic Review and Meta-Analysis of Published Prevalence Estimates

Background: The prevalence of degenerative Aortic Stenosis (AS) is strongly linked to the phenomenon of population aging. While elderly patients form the majority of patients treated with AS, comorbidities place them at high for surgical aortic valve replacement (SAVR). With the new treatment option of transcatheter aortic valve implantation (TAVI), also patients formerly deemed inoperable can now be treated. Robust estimates in an elderly population remain unclear. The objective of this study is to perform a systematic review (SR) and meta-analysis (MA) to identify observational populationbased studies that report prevalence of severe AS in persons 70yrs. Methods: A search of the published literature was conducted in Feb 2012 using Medical databases. General population observational studies, surveys, registries that reported the prevalence of degenerative severe AS in elderly persons ( 70yrs) were included. Although the methods used to diagnose severe AS differed slightly between studies, the cut-off diagnostic criteria used in this analysis, where severe AS is defined as aortic valve area 1 cm, was taken from the ESC AS guidelines. A MA of prevalence estimates was conducted in order to provide a point estimate (with confidence interval) of severe AS prevalence. Heterogeneity was quantified using the I2 measure and its significance was tested with the Q test. Results: A total of 1524 citations were retrieved for review and 7 observational studies reported severe AS in an elderly population. Five studies reported severe AS separately (from other forms of AS) and were included in the MA. The pooled prevalence of severe AS in persons 75yrs was 4.3% (95% CI 3.1%, 5.5%; heterogeneity, I2 52.8%, chi-square p-value 0.095). In persons 80yrs the pooled prevalence of severe AS was 4.8% (95% CI 3.4%, 6.3%; heterogeneity, I2 48.2%, chi-square p-value 0.122). Due to the moderate amount of heterogeneity in the estimates, which was deemed statistically non-significant, a fixed-effect approach was used. Conclusions: Our unique SR shows a prevalence of almost 5% in the octogenarians have severe AS. These figures reconfirm AS as a major disease and form a starting point in light of new less invasive TAV implantation.

Experiência inicial em málaga (Espanha) com prótese aórtica CoreValve para tratamento de estenose aórtica sintomática grave

BACKGROUND: The prevalence of severe aortic stenosis is increasing with the rise in life expectancy. Some patients cannot undergo surgical treatment of aortic stenosis due to associated disorders. We present the results of our experience with the percutaneous treatment of aortic stenosis as an alternative to surgery in high-risk patients. METHODS: This prospective cohort study included 31 consecutive high surgical risk patients with severe and symptomatic aortic stenosis treated with a CoreValve aortic prosthesis from April 2008 to February 2009. All the procedures were undertaken with local anesthesia. In 29 patients we used a femoral artery access, with an 18 F introducer, closing the femoral puncture with a 10 F Prostar, and in two patients the access was via the left subclavian artery. RESULTS: The mean age of the patients was 77.8 ± 8.9 years and the mean logistic EuroSCORE was 17.5 ± 12.6%. The implant was successful in 100% of cases. The peak-to-peak gradient after the implant disappeared. No patient had residual aortic insufficiency Sellers' grade > 2. One-month mortality was 3.2%. A definitive pacemaker was required in 31% of the patients. After a mean follow-up of 154 ± 90 days there were four deaths (1 sudden death and 3 for non-cardiac causes). CONCLUSIONS: Percutaneous implantation of the CoreValve aortic prosthesis as an alternative treatment for severe aortic stenosis in high surgical risk patients is feasible and safe, with a high success rate for the procedure and a percentage of complications below the expected for the surgical risk, as estimated by the EuroSCORE.