Cardiac Staging in Aortic Valve Disease

Patients were categorized into five stages (independent, not additive) depending on the presence or absence of extravalvular (extra aortic valve) cardiac damage or dysfunction as detected by transthoracic echocardiography before AVR—Stage 0: No other cardiac damage detected; Stage 1: LV damage as defined by presence of LV hypertrophy (LV mass index >95 g/m² for women, >115 g/m² for men),⁵ (link) severe LV diastolic dysfunction (E/e′ > 14),⁶ (link) or LV systolic dysfunction (LV ejection fraction <50%); Stage 2: LA or mitral valve damage or dysfunction as defined by the presence of an enlarged left atrium (>34 mL/m²), the presence of atrial fibrillation, or the presence of moderate or severe mitral regurgitation; Stage 3: Pulmonary artery vasculature or tricuspid valve damage or dysfunction as defined by the presence of systolic pulmonary hypertension (systolic pulmonary arterial pressure ≥60 mmHg) or the presence of moderate or severe tricuspid regurgitation⁷ (link)^,⁸ (link); and Stage 4: RV damage as defined by the presence of moderate or severe RV dysfunction (Figure 1).⁵ (link)^,⁶ (link)^,⁹ (link)^,¹⁰ (link) Patients were hierarchically classified in a given stage (worst stage) if at least one of the proposed criteria was met within that stage. These criteria were chosen based on their broad acceptance, prior validation as markers of abnormal cardiac function, their simplicity of acquisition, and their potential for future clinical external generalizability.¹ (link)^,² (link)^,⁵ (link)^,⁶ (link) The classification algorithm as well as the statistical models were defined fully a priori. Frailty was defined as the presence of at least two of the following criteria: (i) Katz index of independence in activities of daily living <6; (ii) 15-m walk time ≥24 s, (iii) serum albumin <3.8 g/dL, and (iv) grip strength <13 kg (women) or <26 kg (men).¹¹ (link)
Transthoracic echocardiograms were obtained at baseline and follow-up using a uniform image acquisition protocol. All studies were analysed by a central core laboratory with quality and measurement methodology previously reported.¹² (link)^,¹³ (link) All adverse events were adjudicated by an independent committee.

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Généreux P., Pibarot P., Redfors B., Mack M.J., Makkar R.R., Jaber W.A., Svensson L.G., Kapadia S., Tuzcu E.M., Thourani V.H., Babaliaros V., Herrmann H.C., Szeto W.Y., Cohen D.J., Lindman B.R., McAndrew T., Alu M.C., Douglas P.S., Hahn R.T., Kodali S.K., Smith C.R., Miller D.C., Webb J.G, & Leon M.B. (2017). Staging classification of aortic stenosis based on the extent of cardiac damage. European Heart Journal, 38(45), 3351-3358.

Publication 2017

Aortic valve Atrial fibrillation Cardiac Echocardiograms Left atrium Lv diastolic dysfunction Lv hypertrophy Lv systolic dysfunction Mitral regurgitation Mitral valve Patients Pulmonary Pulmonary artery Pulmonary hypertension Serum albumin Stage Systolic Systolic arterial pressure Systolic hypertension Tricuspid valve Women

Corresponding Organization :

Other organizations : Cardiovascular Research Foundation, Morristown Medical Center, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Université Laval, Sahlgrenska University Hospital, Baylor Scott & White Health, Cedars-Sinai Medical Center, Cleveland Clinic, Emory University, University of Pennsylvania, Saint Luke's Hospital, Vanderbilt University Medical Center, Columbia University Irving Medical Center, Duke Medical Center, Clinical Research Institute, Stanford University, St. Paul's Hospital, University of British Columbia

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Variable analysis

independent variables

Presence or absence of extravalvular (extra aortic valve) cardiac damage or dysfunction as detected by transthoracic echocardiography before AVR

dependent variables

Patients were categorized into five stages (independent, not additive) depending on the presence or absence of extravalvular (extra aortic valve) cardiac damage or dysfunction

control variables

Transthoracic echocardiograms were obtained at baseline and follow-up using a uniform image acquisition protocol
All studies were analysed by a central core laboratory with quality and measurement methodology previously reported

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