Long‐Term Outcomes in Patients With Mixed Aortic Valve Disease and Preserved Left Ventricular Ejection Fraction
Background Concurrent presence of aortic stenosis and aortic regurgitation is termed mixed aortic valve disease (MAVD). Although multiple articles have addressed patients with “isolated” aortic stenosis or aortic regurgitation, the natural history, impact, and outcomes of MAVD are not well defined....
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.014591 |
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| author | Nicolas Isaza Milind Y. Desai Samir R. Kapadia Amar Krishnaswamy L. Leonardo Rodriguez Richard A. Grimm Julijana Z. Conic Yoshihito Saijo Eric E. Roselli A. Marc Gillinov Douglas R. Johnston Lars G. Svensson Brian P. Griffin Zoran B. Popović |
| author_facet | Nicolas Isaza Milind Y. Desai Samir R. Kapadia Amar Krishnaswamy L. Leonardo Rodriguez Richard A. Grimm Julijana Z. Conic Yoshihito Saijo Eric E. Roselli A. Marc Gillinov Douglas R. Johnston Lars G. Svensson Brian P. Griffin Zoran B. Popović |
| author_sort | Nicolas Isaza |
| collection | DOAJ |
| description | Background Concurrent presence of aortic stenosis and aortic regurgitation is termed mixed aortic valve disease (MAVD). Although multiple articles have addressed patients with “isolated” aortic stenosis or aortic regurgitation, the natural history, impact, and outcomes of MAVD are not well defined. Here, we evaluate long‐term outcomes in patients with MAVD and cardiovascular adaptations to chronic MAVD. Methods and Results This observational cohort study evaluated 862 adult patients (56.8% male) with preserved left ventricular ejection fraction and at least moderate aortic regurgitation and moderate aortic stenosis. Primary outcome was all‐cause mortality. Subgroup analysis was based on treatment modality (aortic valve replacement [AVR] versus medical management). A regression analysis of longitudinal echocardiographic parameters was performed to assess the natural history of MAVD. Mean age was 68±15 years, and mean left ventricular ejection fraction was 58±5%. At 4.6 years (25th–75th percentile range, 1.0–8.7), 58.6% of patients underwent an AVR and 48.8% patients died. In both unadjusted and adjusted Cox survival analysis, AVR was associated with improved survival (hazard ratio, 0.41; 95% CI, 0.34–0.51, P<0.001). Impact of AVR persisted when stratifying the cohort by symptom status and baseline aortic valve area (log rank, P<0.001 for both) and after propensity‐score matching (hazard ratio, 0.40; 95% CI, 0.32–0.50; P<0.001). In the longitudinal analysis, there were statistically significant changes over time in aortic valve peak gradient (P<0.001) and aortic valve area (P<0.001) and only mild increases in left ventricular end‐diastolic (P<0.007) and ‐systolic (P<0.001) volumes. Conclusions MAVD confers a high risk of all‐cause mortality. However, AVR significantly reduces this risk independent of aortic valve area, symptom status, and after controlling for confounding variables. |
| first_indexed | 2024-04-13T16:31:39Z |
| format | Article |
| id | doaj.art-bf066cf7a28f433bbb13051d4d0572e9 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:31:39Z |
| publishDate | 2020-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-bf066cf7a28f433bbb13051d4d0572e92022-12-22T02:39:34ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-04-019710.1161/JAHA.119.014591Long‐Term Outcomes in Patients With Mixed Aortic Valve Disease and Preserved Left Ventricular Ejection FractionNicolas Isaza0Milind Y. Desai1Samir R. Kapadia2Amar Krishnaswamy3L. Leonardo Rodriguez4Richard A. Grimm5Julijana Z. Conic6Yoshihito Saijo7Eric E. Roselli8A. Marc Gillinov9Douglas R. Johnston10Lars G. Svensson11Brian P. Griffin12Zoran B. Popović13Department of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OHDepartment of Cardiovascular Medicine Sydell and Arnold Miller Family Heart & Vascular Institute Cleveland Clinic Foundation Cleveland OHBackground Concurrent presence of aortic stenosis and aortic regurgitation is termed mixed aortic valve disease (MAVD). Although multiple articles have addressed patients with “isolated” aortic stenosis or aortic regurgitation, the natural history, impact, and outcomes of MAVD are not well defined. Here, we evaluate long‐term outcomes in patients with MAVD and cardiovascular adaptations to chronic MAVD. Methods and Results This observational cohort study evaluated 862 adult patients (56.8% male) with preserved left ventricular ejection fraction and at least moderate aortic regurgitation and moderate aortic stenosis. Primary outcome was all‐cause mortality. Subgroup analysis was based on treatment modality (aortic valve replacement [AVR] versus medical management). A regression analysis of longitudinal echocardiographic parameters was performed to assess the natural history of MAVD. Mean age was 68±15 years, and mean left ventricular ejection fraction was 58±5%. At 4.6 years (25th–75th percentile range, 1.0–8.7), 58.6% of patients underwent an AVR and 48.8% patients died. In both unadjusted and adjusted Cox survival analysis, AVR was associated with improved survival (hazard ratio, 0.41; 95% CI, 0.34–0.51, P<0.001). Impact of AVR persisted when stratifying the cohort by symptom status and baseline aortic valve area (log rank, P<0.001 for both) and after propensity‐score matching (hazard ratio, 0.40; 95% CI, 0.32–0.50; P<0.001). In the longitudinal analysis, there were statistically significant changes over time in aortic valve peak gradient (P<0.001) and aortic valve area (P<0.001) and only mild increases in left ventricular end‐diastolic (P<0.007) and ‐systolic (P<0.001) volumes. Conclusions MAVD confers a high risk of all‐cause mortality. However, AVR significantly reduces this risk independent of aortic valve area, symptom status, and after controlling for confounding variables.https://www.ahajournals.org/doi/10.1161/JAHA.119.014591aortic regurgitationaortic stenosismixed aortic valve diseasesurvival |
| spellingShingle | Nicolas Isaza Milind Y. Desai Samir R. Kapadia Amar Krishnaswamy L. Leonardo Rodriguez Richard A. Grimm Julijana Z. Conic Yoshihito Saijo Eric E. Roselli A. Marc Gillinov Douglas R. Johnston Lars G. Svensson Brian P. Griffin Zoran B. Popović Long‐Term Outcomes in Patients With Mixed Aortic Valve Disease and Preserved Left Ventricular Ejection Fraction Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic regurgitation aortic stenosis mixed aortic valve disease survival |
| title | Long‐Term Outcomes in Patients With Mixed Aortic Valve Disease and Preserved Left Ventricular Ejection Fraction |
| title_full | Long‐Term Outcomes in Patients With Mixed Aortic Valve Disease and Preserved Left Ventricular Ejection Fraction |
| title_fullStr | Long‐Term Outcomes in Patients With Mixed Aortic Valve Disease and Preserved Left Ventricular Ejection Fraction |
| title_full_unstemmed | Long‐Term Outcomes in Patients With Mixed Aortic Valve Disease and Preserved Left Ventricular Ejection Fraction |
| title_short | Long‐Term Outcomes in Patients With Mixed Aortic Valve Disease and Preserved Left Ventricular Ejection Fraction |
| title_sort | long term outcomes in patients with mixed aortic valve disease and preserved left ventricular ejection fraction |
| topic | aortic regurgitation aortic stenosis mixed aortic valve disease survival |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.014591 |
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