Prognostic Impact of Cardiac Damage Across the Spectrum of Aortic Stenosis Severity: Results From a Large Real-World Database

BACKGROUND

A staging classification of aortic stenosis (AS) based on extent of cardiac damage (CD) has been validated in multiple patient (pt) cohorts with severe or moderate AS. However, data for untreated pts across degrees of AS severity are lacking.

METHODS

We analyzed pts with AS in a deidentified real-world dataset including 812,577 echocardiograms (497,086 pts) from 12 US hospitalswith appropriate permissions (egnite Database; egnite, Aliso Viejo, CA, US). Pts >18 years old were classified by AS severity (mild, moderate, severe) and CD staging (as previously described). Outcomes were examined using Kaplan-Meier estimates, with censoring at treatment date for AS/last clinical encounter, and compared using the log-rank test.

RESULTS

Of 313,390 pts with available AS severity assessment, 13,612 had both ≥mild AS and evaluable CD staging. Median (IQR) time from staging to censor/death was 326 (54-751) days. Mild, moderate, or severe AS was diagnosed in 4,791 (35%), 3,591 (26%), and 5,230 (38%) pts, and CD staging was Stage 0, 1, 2, 3, or 4 in 521 (4%), 1,456 (11%), 5,856 (43%), 1,732 (13%), and 4,047 (30%) pts, respectively. Two-year mortality across all AS severities was 8%, 11%, 14%, 26%, and 33% for Stages 0, 1, 2, 3, or 4, respectively, p<0.0001. Higher CD stage was associated with greater mortality at each AS severity (Figure).

CONCLUSIONS

This analysis of untreated pts with AS demonstrates that progressive CD has important prognostic and therapeutic implications across all degrees of AS severity.