Article (Scientific journals)
Association of Mortality With Aortic Stenosis Severity in Outpatients: Results From the VALVENOR Study.
Coisne, Augustin; Montaigne, David; Aghezzaf, Samy et al.
2021In JAMA Cardiology, 6 (12), p. 1424-1431
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Keywords :
Aged; Aortic Valve/diagnostic imaging; Aortic Valve Stenosis/complications/diagnosis/mortality; Cause of Death/trends; Death, Sudden/epidemiology/etiology; Echocardiography; Europe/epidemiology; Female; Follow-Up Studies; Humans; Male; Outpatients; Retrospective Studies; Severity of Illness Index; Survival Rate/trends; Time Factors
Abstract :
[en] IMPORTANCE: Modern data regarding incidence and modes of death of patients with aortic stenosis (AS) are restricted to tertiary centers or studies of aortic valve replacement (AVR). OBJECTIVE: To provide new insights into the natural history of outpatients with native AS based on a large regionwide population study with inclusion by all cardiologists regardless of their mode of practice. DESIGN, SETTING, AND PARTICIPANTS: Between May 2016 and December 2017, consecutive outpatients with mild (peak aortic velocity, 2.5-2.9 m/s), moderate (peak aortic velocity, 3-3.9 m/s), and severe (peak aortic velocity, ≥4 m/s) native AS graded by echocardiography were included by 117 cardiologists from the Nord-Pas-de-Calais region in France. Analysis took place between August and November 2020. MAIN OUTCOMES AND MEASURES: Natural history, need for AVR, and survival of patients with AS were followed up. Indications for AVR were based on current guideline recommendations. RESULTS: Among 2703 patients (mean [SD] age, 76.0 [10.8] years; 1260 [46.6%] women), 233 (8.6%) were recruited in a university public hospital, 757 (28%) in nonuniversity public hospitals, and 1713 (63.4%) by cardiologists working in private practice. A total of 1154 patients (42.7%) had mild, 1122 (41.5%) had moderate, and 427 (15.8%) had severe AS. During a median (interquartile range) of 2.1 (1.4-2.7) years, 634 patients underwent AVR and 448 died prior to AVR. Most deaths were cardiovascular (200 [44.7%]), mainly associated with congestive heart failure (101 [22.6%]) or sudden death (60 [13.4%]). Deaths were noncardiovascular in 186 patients (41.5%) and from unknown causes in 62 patients (13.8%). Compared with patients with mild AS, there was increased cardiovascular mortality in those with moderate (hazard ratio, 1.47 [95% CI, 1.07-2.02]) and severe (hazard ratio, 3.66 [95% CI, 2.52-5.31]) AS. The differences remained significant when adjusted for baseline characteristics or in time-dependent analyses considering AS progression. In asymptomatic patients, moderate and mild AS were associated with similar cardiovascular mortality (hazard ratio, 0.99 [95% CI, 0.44-2.21]). CONCLUSIONS AND RELEVANCE: While patients in this study with moderate AS had a slightly higher risk of cardiovascular death than patients with mild AS, this risk was much lower than that observed in patients with severe AS. Moreover, in asymptomatic patients, moderate and mild AS were associated with similar cardiovascular mortality.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Coisne, Augustin;  University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID,
Montaigne, David;  University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID,
Aghezzaf, Samy;  University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID,
Ridon, Hélène;  University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID,
Mouton, Stéphanie;  University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID,
Richardson, Marjorie;  University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID,
Polge, Anne-Sophie;  University Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID,
LANCELLOTTI, Patrizio  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service de cardiologie ; Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Anthea
Bauters, Christophe;  University Lille, Inserm, CHU Lille, Institut Pasteur, U1167, Lille, France.
VALVENOR, Investigators
Other collaborator :
Abramovici, Luc
Aisenfarb, Jean-Charles
Alaoui, Moulay
Amiar, Ahmed
Arabidze, Mariam
Aumegeat, Valérie
Avez-Lemaire, Laurence
Bardet, Hélène
Bauley, Karine
Becquart, Jean
Ben Abda, Aida
Vaksmann, Arthur
Vandamme, Dominique
Vanesson, Claire
Vaquette, Bruno
Verbrugge, Eric
Verhaeghe, Mathieu
Viart, Rémy
Vodoungnon, Hubert
Voyez, Julien
Werquin, Steve
Biausque, Frédéric
Wibaux, Maud
Boudghene Stambouli, Fanny
Boutié, Bertrand
Broucqsault, Damien
Bruffau, Jean-Michel
Brullard, Benoit
Carpentier, Laurent
Caudmont, Sébastien
Chachoua, Karim
Chmait, Akram
Clement-Dupont, Maïwenn
Cordier, Christophe
Cosenza, Alessandro
Coulomb, Jean-Pierre
Cousin, Vladimir
Dassonvalle, Elise
de Geeter, Guillaume
de Groote, Pascal
Decoulx, Eric
Delomez, Maxence
Delsart, Pascal
Destombes, François
Detis, Nicolas
Devillers, Michel
Domanski, Olivia
Duchemin, Audrey
Dujardin, Xavier
Duva Pentiah, Anju
Endjah, Nima
Equine, Octave
Fertin, Marie
Fournier, Bruno
Garin, Dauphine
Gongora, Antonio
Greffe, Lorraine
Hannebicque, Gery
Haye, Jérôme
Hebbar, Eléonore
Hennebelle, Vincent
Hennebert, Olivier
Houdain, Gérard
Hubert, Arnaud
Hudelo, Charles
Hus, Thibault
Jabourek, Olivier
Jacquelinet, Mathilde
Jacquemart, Thierry
Jellouli, Belaid
Jeu, Antoine
Kouidri, Messaoud
Kozlowski, Francis
Lallemant, Robert
Lamblin, Nicolas
Langlois, Patricia
Ledieu, Guillaume
Lefetz, Yann
Lejeune, Philippe
Leleu, François
Lemaire, Nestor
Lubret, Rémy
Madika, Anne-Laure
Marboeuf, Philippe
Meurice, Thibaud
Meurice, Jonathan
Millaire, Alain
Mouquet, Frédéric
Musschoot, Aurélie
Mycinski, Christophe
Neicu, Dan
Nugue, Olivier
Ouardani, Rahma
Ouchallal, Karima
Passard, François
Pecheux, Max
Pedelhez, Karine
Petit, Alain
Philias, André
Pilato, Rosario
Pruvost, Philippe
Quercy, Arnaud
Sagot, Marc
Sautiere-Tricot, Karine
Savoye, Christine
Segrestin, Benoit
Taghipour, Kouroch
Taverne, Véronique
Tchatchoua, Dieudonné
Tondeux, Sylvie
Tricot, Olivier
More authors (101 more) Less
Language :
English
Title :
Association of Mortality With Aortic Stenosis Severity in Outpatients: Results From the VALVENOR Study.
Publication date :
01 December 2021
Journal title :
JAMA Cardiology
ISSN :
2380-6583
eISSN :
2380-6591
Publisher :
American Medical Association, Chicago, Us il
Volume :
6
Issue :
12
Pages :
1424-1431
Peer reviewed :
Peer Reviewed verified by ORBi
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