Causes of Death in Patients with Severe Aortic Stenosis: An Observational study

Abstract

Whether patients with severe aortic stenosis (AS) die because of AS-related causes is an important issue for the management of these patients. We used data from CURRENT AS registry, a Japanese multicenter registry, to assess the causes of death in severe AS patients and to identify the factors associated with non-cardiac mortality. We enrolled 3815 consecutive patients with a median follow-up of 1176 days; the 1449 overall deaths comprised 802 (55.3%) from cardiac and 647 (44.7%) from non-cardiac causes. Heart failure (HF) (25.7%) and sudden death (13.0%) caused the most cardiac deaths, whereas infection (13.0%) and malignancy (11.1%) were the main non-cardiac causes. According to treatment strategies, infection was the most common cause of non-cardiac death, followed by malignancy, in both the initial aortic valve replacement (AVR) cohort (N = 1197), and the conservative management cohort (N = 2618). Both non-cardiac factors (age, male, body mass index <22, diabetes, prior history of stroke, dialysis, anemia, and malignancy) and cardiac factors (atrial fibrillation, ejection fraction <68%, and the initial AVR strategy) were associated with non-cardiac death. These findings highlight the importance of close monitoring of non-cardiac comorbidities, as well as HF and sudden death, to improve the mortality rate of severe AS patients.

Arrhythmic Risk in Elderly Patients Candidates to Transcatheter Aortic Valve Replacement: Predictive Role of Repolarization Temporal Dispersion

“…Furthermore, sympathetic over-activity, typical in chronic heart failure, could also play an important role as malignant ventricular arrhythmias’ trigger. In such a context, there are two previous observations corroborating these claims: it was recently confirmed that the sudden cardiac death during AS remains statistically important (Minamino-Muta et al, 2017) and, some non-invasive electrocardiographic (ECG) markers were found significantly associated to a poor outcome in elderly patients with AS after the transcatheter aortic valve replacement (TAVR) (Piccirillo et al, 2018).…”

Association between atrial fibrillation, atrial enlargement, and left ventricular geometric remodeling

“…In our study, we provided the link between LV geometric patterns and AF prevalence through the contribution of atrial enlargement and decreased LVEF. AF and LA enlargement is a risk factor for ischemic stroke and may contribute to doubling all-cause 31 and CV deaths 14 , and, in a specific condition, non-CV deaths 32 . However, anticoagulants were sub-optimally prescribed in these patients.…”

Use of routinely captured echocardiographic data in the diagnosis of severe aortic stenosis

“…Echocardiographic data captured in routine clinical care has been leveraged to populate patient registries and perform retrospective observational studies, including studies that have informed the outcomes of patients with asymptomatic severe AS6 and causes of death among patients with severe AS 7. These prior studies have applied guideline recommended quantitative echocardiographic measures, including valve area, in the identification of patients with severe AS.…”