Staging classification of aortic stenosis based on the extent of cardiac damage.


Journal Article

Aims: In patients with aortic stenosis (AS), risk stratification for aortic valve replacement (AVR) relies mainly on valve-related factors, symptoms and co-morbidities. We sought to evaluate the prognostic impact of a newly-defined staging classification characterizing the extent of extravalvular (extra-aortic valve) cardiac damage among patients with severe AS undergoing AVR. Methods and results: Patients with severe AS from the PARTNER 2 trials were pooled and classified according to the presence or absence of cardiac damage as detected by echocardiography prior to AVR: no extravalvular cardiac damage (Stage 0), left ventricular damage (Stage 1), left atrial or mitral valve damage (Stage 2), pulmonary vasculature or tricuspid valve damage (Stage 3), or right ventricular damage (Stage 4). One-year outcomes were compared using Kaplan-Meier techniques and multivariable Cox proportional hazards models were used to identify 1-year predictors of mortality. In 1661 patients with sufficient echocardiographic data to allow staging, 47 (2.8%) patients were classified as Stage 0, 212 (12.8%) as Stage 1, 844 (50.8%) as Stage 2, 413 (24.9%) as Stage 3, and 145 (8.7%) as Stage 4. One-year mortality was 4.4% in Stage 0, 9.2% in Stage 1, 14.4% in Stage 2, 21.3% in Stage 3, and 24.5% in Stage 4 (Ptrend < 0.0001). The extent of cardiac damage was independently associated with increased mortality after AVR (HR 1.46 per each increment in stage, 95% confidence interval 1.27-1.67, P < 0.0001). Conclusion: This newly described staging classification objectively characterizes the extent of cardiac damage associated with AS and has important prognostic implications for clinical outcomes after AVR.

Full Text

Duke Authors

Cited Authors

  • Généreux, P; Pibarot, P; Redfors, B; Mack, MJ; Makkar, RR; Jaber, WA; Svensson, LG; Kapadia, S; Tuzcu, EM; Thourani, VH; Babaliaros, V; Herrmann, HC; Szeto, WY; Cohen, DJ; Lindman, BR; McAndrew, T; Alu, MC; Douglas, PS; Hahn, RT; Kodali, SK; Smith, CR; Miller, DC; Webb, JG; Leon, MB

Published Date

  • December 1, 2017

Published In

Volume / Issue

  • 38 / 45

Start / End Page

  • 3351 - 3358

PubMed ID

  • 29020232

Pubmed Central ID

  • 29020232

Electronic International Standard Serial Number (EISSN)

  • 1522-9645

Digital Object Identifier (DOI)

  • 10.1093/eurheartj/ehx381


  • eng

Conference Location

  • England