Author + information
- Tomohiko Taniguchi1,
- Takeshi Morimoto2,
- Hiroki Shiomi1,
- Kenji Ando3,
- Takeshi Kitai4,
- Yuichi Kawase5,
- Chisato Izumi6 and
- Takeshi Kimura1
The annual incidence of sudden cardiac death (SCD) has been reported to be approximately 1%/year in asymptomatic patients with severe aortic stenosis (AS), although most of the previous studies were relatively small single center studies. There is a paucity of data regarding the predictive clinical factors for an increased risk of SCD in patients with severe AS.
We evaluated the timing, incidence and risk factors of SCD using data from a large multicenter registry enrolling 3815 consecutive patients who met the definition of severe AS for the first time between 2003 and 2011. Cumulative incidence of SCD censored at surgical or transcatheter aortic valve replacement (AVR) was estimated by the Kaplan-Meier method stratified by the presence (N=405) or absence of hemodialysis (HD) (N=3410), because we previously reported an extremely high rate of SCD in HD patients. Median follow-up period was 1334 days with 93% follow-up at 2-year. SCD was defined as unexplained death in previously stable patients according to Valve Academic Research Consortium definitions.
The mean age in the entire cohort was 79 years, and the prevalence of male and prior myocardial infarction was 38% and 8% respectively. SCD occurred in 175 patients without surgical or transcatheter AVR. Among 82 patients experiencing SCD without any symptoms at baseline, 54 patients (66%) died abruptly without preceding symptoms and 35 (65%) of these sudden death occurred within 3 months of the last clinical follow-up visit. The cumulative 5-year incidences of SCD were 38.3% (annual incidence of 7.7%) in the HD group, and 8.7% (1.7%/year) in the non-HD group (P<0.001). The cumulative 5-year incidence of SCD was significantly higher in symptomatic patients than in asymptomatic patients (13.5% versus 9.1%, P<0.001). Multivariable analysis demonstrated that the clinical factors associated with a higher risk for SCD were age ≥80 (hazard ratio [HR] 1.57; 95% confidence interval [CI] 1.12-2.22), male (HR 1.53; 95% CI 1.09-2.15), HD (HR 4.27; 95% CI 2.78-6.50), prior myocardial infarction (HR 2.13; 95% CI 1.30-3.52), peak aortic jet velocity ≥5m/s (HR 1.76; 95% CI 1.10-2.71) and left ventricular ejection fraction <60% (HR 1.71; 95% CI 1.22-2.40).
The incidence of SCD in non-HD patients with severe AS might be higher than that reported in previous reports. Several baseline clinical characteristics as well as echocardiographic parameters were associated with increased risk of SCD in patients with severe AS.
STRUCTURAL: Valvular Disease: Aortic