Cardiac Damage Staging Classification Predicts Prognosis in All the Major Subtypes of Severe Aortic Stenosis: Insights from the National Echo Database Australia

Evolution and Prognostic Impact of Cardiac Damage After Aortic Valve Replacement

“…As expected, the extent of cardiac damage was strongly and positively associated with mortality and adverse events at 1-year post-AVR. Since the initial publication, the prognostic impact of this classification has been validated in multiple cohorts of patients with severe [4][5][6][7][8][9][10][11][12][13][14] and moderate AS 15 and among patients with and without symptoms. 16,17 Although the prognostic importance of extravalvular cardiac damage before AVR is thus wellestablished, the impact of AVR on progression or regression of cardiac damage and its association with subsequent prognosis is unknown.…”

The prognostic significance of stroke volume index in low gradient severe aortic stenosis: from the national echo database of Australia

“…Those with SVI < 35 ml/m 2 had an elevated relative mortality risk on multivariate analysis by 80–100% at 1-year and by 40–50% at 3-years, compared to those with ‘normal’ flow. This effect remained very similar following additional adjustment for calculated LVEF% on multivariate analysis, beyond the original adjustment for the extent of extra aortic valve cardiac disease using the established Cardiac Damage Staging Classification [ 11 , 16 , 17 ].…”

“…LVEF was obtained by following hierarchal methods: volumetric apical biplane (Simpson’s), volumetric apical four-chamber, volumetric apical two-chamber, or finally by the Teichholz formula. Cardiac Damage Staging [ 16 ] for each patient was calculated as recently described elsewhere using available echo parameters [ 11 ]. The presence of Atrial Fibrillation rhythm at time of echocardiography was inferred from the E and A velocity profile measured at the mitral valve inflow using pulse wave Doppler.…”

“…As previously reported [ 11 ], AVR status was identified using text recognition software of the free text and conclusions of each echo report in the database, rather than with direct linkage to national surgical or interventional databases. Therefore, patients were only recorded to have undergone AVR during follow-up, either surgically or with a TAVI procedure, if any of their subsequent available echocardiograms in the database reported evidence of a replaced or implanted AV.…”

“…We analysed data from the National Echo Database of Australia (NEDA)—a large Australia-wide registry containing data from over one million echocardiograms, from more than 600,000 adults being routinely investigated for heart disease. This unique resource has already generated clinically important insights into the prevalence and outcomes of AS [ 9 , 10 ] and LFLG AS specifically [ 1 , 11 ].…”