Author + information
- João Cavalcante1,
- Michael Sharbaugh2,
- Andrew Althouse3,
- Dustin Kliner3,
- Joon Lee3,
- John Schindler3 and
- Thomas Gleason4
A new staging system encompassing the extent of cardiac damage has been proposed for patients with aortic stenosis undergoing aortic valve replacement. We sought to validate this staging system using our large, single-center cohort of patients who have undergone TAVR.
The classification algorithm used was similar to that recently published by Genereux et al. ( EHJ 2017 ). The criteria were: stage 1 (LV damage - increased LV mass index, E/e’ > 14, LVEF ≤ 50%); stage 2 (LA/mitral damage – LA volume index > 34 ml/m2, moderate-severe mitral regurgitation, atrial fibrillation, AFib); stage 3 (PA/tricuspid damage – PA systolic pressure ≥ 60 mmHg, moderate-severe TR); stage 4 (moderate-severe RV dysfunction). Kaplan-Meier analysis was performed to test the association between the AS staging system and mortality.
We included 480 patients with severe AS who underwent TAVR. The prevalence of stage 1, 2, 3 and 4 was 13%, 62%, 21% and 4%, respectively. Higher STS-PROM and Afib burden increased at each stage, whereas stroke volume index and tricuspid annular plane systolic excursion, a measurement of RV function, progressively decreased at each stage. The AS staging system showed a strong graded relationship with mortality (Figure).
Extent of cardiac damage can be easily computed in patients undergoing TAVR evaluation. The proposed staging classification demonstrates a strong relationship between the baseline extent of cardiac damage and survival after TAVR. Implementation of the staging system might improve risk-stratification in TAVR patients.
STRUCTURAL: Valvular Disease: Aortic