Severe Aortic Stenosis in Dialysis Patients

Kawase, Yoshiaki; Taniguchi, Tomohiko; Morimoto, Takeshi; Kadota, Kazushige; Iwasaki, Keiichiro; Kuwayama, Akimune; Ohya, Masanobu; Shimada, Toshio; Amano, Hidewo; Maruo, Takeshi; Fuku, Yasushi; Izumi, Chisato; Kitai, Takeshi; Saito, Naritatsu; Minamino‐Muta, Eri; Kato, Takao; Inada, Tsukasa; Inoko, Moriaki; Ishii, Katsuhisa; Komiya, Tatsuhiko; Hanyu, Michiya; Minatoya, Kenji; Kimura, Takeshi

doi:10.1161/jaha.116.004961

Cited by 45 publications

(23 citation statements)

References 21 publications

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“…We thus selected 10 clinically relevant factors as the potential risk factors with strong evidence as listed in Table 1 for parsimonious models. This was consistent with our previous report 14 except for the addition of prior myocardial infarction, male sex, body mass index <22, and left ventricular ejection fraction (LVEF). We included LVEF <60% instead of the traditional LVEF <50% as a potential risk predictor because we previously reported that the negative prognostic impact of LVEF 50% to 59% was comparable to that of LVEF <50% in patients with severe AS who were managed conservatively.…”

Section: Discussionsupporting

confidence: 93%

“…15 As the subgroup analyses, we assessed the cumulative incidence of sudden death in patients with hemodialysis (HD) (N=405) and non-HD patients (N=3410) because we previously reported an extremely high rate of sudden death in HD patients. 14 We also explored the clinical characteristics associated with sudden death in non-HD patients. Statistical analyses were conducted by a physician (T. Taniguchi) and a statistician (T. Morimoto) with the use of JMP 10.0.2 (SAS Institute Inc, Cary, NC) or SAS 9.4 (SAS Institute Inc, Cary, NC).…”

Section: Discussionmentioning

confidence: 99%

“…We included LVEF <60% instead of the traditional LVEF <50% as a potential risk predictor because we previously reported that the negative prognostic impact of LVEF 50% to 59% was comparable to that of LVEF <50% in patients with severe AS who were managed conservatively . As the subgroup analyses, we assessed the cumulative incidence of sudden death in patients with hemodialysis (HD) (N=405) and non‐HD patients (N=3410) because we previously reported an extremely high rate of sudden death in HD patients . We also explored the clinical characteristics associated with sudden death in non‐HD patients.…”

Section: Methodsmentioning

confidence: 99%

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Sudden Death in Patients With Severe Aortic Stenosis: Observations From the CURRENT AS Registry

Taniguchi

Morimoto

Shiomi

et al. 2018

JAHA

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BackgroundThe annual incidence of sudden death has been reported to be low (<1%/year) in asymptomatic patients with severe aortic stenosis (AS), and there is a paucity of data on the risk factors of sudden death in patients with severe AS.Methods and ResultsWe evaluated the incidence and risk factors of sudden death during the median follow‐up period of 1334 days in the Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis (CURRENT AS) registry enrolling 3815 consecutive patients with severe AS between 2003 and 2011. The mean age was 78 years, and the prevalences of male sex and prior myocardial infarction were 38% and 8%, respectively. Sudden death occurred in 175 patients without aortic valve replacement. The cumulative 5‐year incidences of sudden death, censored at aortic valve replacement, which accounted for the competing risk, were 9.2% in symptomatic patients and 7.2% (1.4%/year) in asymptomatic patients (P<0.001). Among 82 asymptomatic patients experiencing sudden death, 54 patients (66%) died abruptly without any preceding symptoms, and 35 (65%) of these sudden deaths occurred within 3 months of the last clinical follow‐up visit. Independent risk factors for sudden death were hemodialysis (hazard ratio [HR] 3.63; 95% confidence interval [CI] 2.42‐5.43), prior myocardial infarction (HR 2.11; 95% CI 1.28‐3.50), body mass index <22 (HR 1.51; 95% CI 1.03‐2.21), peak aortic jet velocity ≥5 m/s (HR 1.76; 95% CI 1.12‐2.78), and left ventricular ejection fraction <60% (HR 1.52; 95% CI 1.08‐2.14).ConclusionsThe incidence of sudden death in asymptomatic patients with severe AS might be higher than that reported in previous reports. Several baseline clinical and echocardiographic characteristics were associated with increased risk of sudden death.Clinical Trial Registration URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000012140.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Sudden Death in Patients With Severe Aortic Stenosis: Observations From the CURRENT AS Registry

Taniguchi

Morimoto

Shiomi

et al. 2018

JAHA

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“…Asymptomatic patients with a BNP level of <100 pg/mL had a relatively low event rate at 1 year of follow-up, who might be safely followed up with watchful waiting strategy. Finally, in the CURRENT AS registry, HD,46 anaemia47 and tricuspid regurgitation48 were associated with poor clinical outcomes in patients with severe AS.…”

Section: Management Of Asymptomatic Patients With Severe Asmentioning

confidence: 98%

Contemporary issues in severe aortic stenosis: review of current and future strategies from the Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis registry

Taniguchi

Morimoto

Takeji

et al. 2020

Heart

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Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis (CURRENT AS) registry was a large Japanese multicentre retrospective registry of consecutive patients with severe aortic stenosis (AS) before introduction of transcatheter aortic valve implantation. We sought to overview the data from the CURRENT AS registry to discuss the three major contemporary issues related to clinical practice in patients with severe AS: (1) under-referral/underuse of surgical aortic valve replacement (SAVR) in symptomatic patients with severe AS, (2) management of asymptomatic patients with severe AS and (3) management of patients with low-gradient severe aortic stenosis (LG-AS). First, despite the dismal prognosis of symptomatic patients with severe AS, SAVR, including those performed during follow-up, was reported to be underused. In the CURRENT AS registry, overall 53% of symptomatic patients underwent aortic valve replacement (AVR) during follow-up. Second, we reported that compared with conservative strategy, initial AVR strategy was associated with lower risk of all-cause death and heart failure hospitalisation in asymptomatic patients with severe AS. Although current recommendations for AVR are mainly dependent on the patient symptoms, some patients may not complain of any symptom because of their sedentary lifestyle. We also reported several important objective factors associated with worse clinical outcomes in asymptomatic patients with severe AS for risk stratification. Finally, initial AVR strategy was associated with better long-term clinical outcomes than conservative strategy in both patients with high-gradient AS and patients with LG-AS. The favourable effect of initial AVR strategy was also seen in patients with LG-AS with left ventricular ejection fraction of ≥50%.

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“…The incidence of aortic valve calcification in ESKD nearly doubles that in the general population, and it usually tracks with duration of dialysis (15). Outcomes with severe aortic stenosis in patients on dialysis are worse than those in the general population (35).…”

Section: Valvular Heart Diseasementioning

confidence: 99%

Preoperative Noncoronary Cardiovascular Assessment and Management of Kidney Transplant Candidates

Baman¹,

Knapper²,

Raval

et al. 2019

CJASN

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The pretransplant risk assessment for patients with ESKD who are undergoing evaluation for kidney transplant is complex and multifaceted. When considering cardiovascular disease in particular, many factors should be considered. Given the increasing incidence of kidney transplantation and the growing body of evidence addressing ESKD-specific cardiovascular risk profiles, there is an important need for a consolidated, evidence-based model that considers the unique cardiovascular challenges that these patients face. Cardiovascular physiology is altered in these patients by abrupt shifts in volume status, altered calcium-phosphate metabolism, high-output states (in the setting of arteriovenous fistulization), and adverse geometric and electrical remodeling, to name a few. Here, we present a contemporary review by addressing cardiomyopathy/heart failure, pulmonary hypertension, valvular dysfunction, and arrhythmia/sudden cardiac death within the ESKD population.

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Severe Aortic Stenosis in Dialysis Patients

Cited by 45 publications

References 21 publications

Sudden Death in Patients With Severe Aortic Stenosis: Observations From the CURRENT AS Registry

Sudden Death in Patients With Severe Aortic Stenosis: Observations From the CURRENT AS Registry

Contemporary issues in severe aortic stenosis: review of current and future strategies from the Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis registry

Preoperative Noncoronary Cardiovascular Assessment and Management of Kidney Transplant Candidates

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