Effect of Asymptomatic Severe Aortic Stenosis on Outcomes of Individuals Aged 80 and Older

Suzuki, Atsushi; Tajiri, Kazuko; Ishizu, Tomoko; Nakayama, Mio; Hoshi, Tomoya; Suzuki, Seiichi; Hatsutori, Mikiko; Sato, Noriko; Takayama, Shingo; Kawano, Motoharu; Aonuma, Kazutaka; Nogami, Akihiko

doi:10.1111/jgs.15527

Cited by 6 publications

(2 citation statements)

References 18 publications

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“…This indicates that the increasing severity of AS with age influences SR. Furthermore, although the distribution of AS by sex showed higher proportions of AS in women than in men, 15,16,25,26 SR in the present study did not significantly differ by sex in individuals with AS. We think that the increase in the prevalence of AS over time was mainly driven by a sex imbalance in older women in this study, possibly due to the longer life expectancy and higher proportion of older women than men.…”

Section: Discussioncontrasting

confidence: 86%

Temporal trends in incidence, prevalence, and death of aortic stenosis in Korea: a nationwide population‐based study

et al. 2022

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Aims We aim to determine the temporal trends of incidence, prevalence, and death of aortic stenosis (AS, I35.0) in an East Asian population. Methods and results Data for 3773 patients who were newly diagnosed with AS from 2006 through 2017 were extracted from the National Health Insurance Service in Korea. The age‐standardized incidence rate, prevalence rate, and death rate, survival rate (SR), and death risk of AS were calculated. Overall, the mean (standard deviation) age of AS patients was 69.9 (15.3) years [66.2 (15.7) years for men and 72.7 (14.4) years for women (P = 0.007)], and the proportion of men was 42.7%. The proportion of AS patients ≥60 years old was 80% (71.8% in men and 86% in women, P < 0.001). The proportion of patients who died of AS was 36.4% during the period from 2006 through 2017. The most common causes of death were disease of the circulatory system. The age‐standardized incidence, prevalence, and death rates in 2017 were 0.85, 2.79, and 0.58 persons per 100 000 persons, respectively. The 10 year SR was 49.2%. The higher adjusted HRs [95% CI] for AS were observed in 70‐ to 79‐year‐old people (9.08 [1.27, 64.7], P = 0.027), in individuals 80 years of age or older (22.7 [3.18, 161.9], P = 0.001), in men (1.46 [1.31, 1.63], P < 0.001), among the middle socioeconomic group (1.19 [1.03, 1.37], P = 0.016), among the lower income levels (1.32 [1.17, 1.49], P < 0.001), in those with myocardial infarction (1.57 [1.16, 2.13], P = 0.003), with heart failure (1.63 [1.44, 1.85], P < 0.001), with ischaemic stroke (3.26 [1.20, 8.85], P = 0.015), with haemorrhagic stroke (2.51 [1.94, 3.25], P = 0.02), with chronic kidney disease (2.51 [1.94, 3.25], P < 0.001), and with malignant neoplasm (2.33 [1.64, 3.31], P < 0.001). Conclusions The proportion of AS at age ≥60 years was 80%. For AS, the age‐standardized incidence rates were steady, prevalence rates increased, and death rates decreased by year over a decade. The 10 year SR of AS was about 50%. The most common cause of death in AS was disease of the circulatory system. Given the progressively higher incidence of AS with age continued efforts are required to increase awareness regarding AS‐related symptoms and potential complications in aged people.

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Section: Discussioncontrasting

confidence: 86%

Temporal trends in incidence, prevalence, and death of aortic stenosis in Korea: a nationwide population‐based study

et al. 2022

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“…Severe AS portends poor prognosis even when asymptomatic, and valve replacement has been shown to improve outcomes. 9,[18][19][20][21] As access to transcatheter interventions for AS has become more readily available, the ability to accurately assess AS by echocardiography and identify those patients with severe AS who may benefit the most from intervention is crucial.…”

Section: Discussionmentioning

confidence: 99%

Progression of aortic stenosis and echocardiographic criteria for its severity

Kebed

Sun

Addetia

et al. 2020

European Heart Journal - Cardiovascular Imaging

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Aims Guidelines-recommended criteria for identifying severe aortic stenosis (AS) are based on small, homogenous cohorts of patients, leading to potentially inconsistent or missed diagnosis. We used a large cohort of patients with varying degrees of AS to (i) characterize its progression; (ii) evaluate the influence of demographic and echocardiographic variables; and (iii) derive haemodynamically consistent cut-off values. Methods and results We identified 916 patients with mild to severe AS who had undergone >1 echocardiographic study (N = 2547). For each study, aortic valve area (AVA), peak transaortic velocity (Vmax), and mean pressure gradient (ΔP) were extracted. Annual rates of AVA change were determined by a linear mixed-effects model. To determine the prevalence of inconsistent diagnosis of severe AS, AVA was plotted against ΔP and Vmax, with quadrants defined using guidelines-recommended cut-offs. The rate of AVA change was −0.070 ± 0.003 cm2/year and was more rapid in men than women and in Whites than African Americans. AVA = 1 cm2 corresponded to ΔP = 32 mmHg and Vmax = 3.7 m/s, causing discrepancies in defining severe AS in 480 (19%) and 458 (18%) studies, respectively. Conversely, ΔP = 40 mmHg corresponded to AVA = 0.89 cm2 and Vmax = 4.0 m/s corresponded to AVA = 0.92 cm2, confirming the inconsistency of the guidelines. Notably, discrepancy rate was higher in 206 patients with low flow (SVi < 35 mL/m2): 40% vs. 16% in the remaining patients. Conclusion Our findings demonstrated gender- and race-related differences in AS progression and underscored the need to refine the multiparametric criteria for diagnosis of severe AS to minimize internal inconsistencies, which are high with the current cut-offs and amplified in patients with low stroke volumes.

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Natural History of Asymptomatic Severe Aortic Stenosis and the Association of Early Intervention With Outcomes

et al. 2020

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Effect of Asymptomatic Severe Aortic Stenosis on Outcomes of Individuals Aged 80 and Older

Abstract: Asymptomatic severe AS has a major effect on prognosis even in very old adults.

Cited by 6 publications

References 18 publications

Temporal trends in incidence, prevalence, and death of aortic stenosis in Korea: a nationwide population‐based study

Temporal trends in incidence, prevalence, and death of aortic stenosis in Korea: a nationwide population‐based study

Progression of aortic stenosis and echocardiographic criteria for its severity

Natural History of Asymptomatic Severe Aortic Stenosis and the Association of Early Intervention With Outcomes

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