Long-term Prognosis of Mild to Moderate Aortic Stenosis and Coronary Artery Disease

다국어 초록 (Multilingual Abstract)

Background: There is an incomplete understanding of the natural course of mild to moderate aortic stenosis (AS). We aimed to evaluate the natural course of patients with mild to moderate AS and its association with coronary artery disease (CAD).
Methods: We retrospectively analyzed 787 patients diagnosed with mild to moderate AS using echocardiography between 2004 and 2010. Cardiac death and aortic valve replacement (AVR) for AS were assessed.
Results: A median follow-up period was 92 months. Compared to the general population, patients with mild to moderate AS had a higher risk of cardiac death (hazard ratio [HR], 17.16; 95% confidence interval [CI], 13.65–21.59; P < 0.001). Established CAD was detected in 22.4% and associated with a significantly higher risk of cardiac mortality (adjusted HR, 1.62; 95% CI, 1.04–2.53; P = 0.033). The risk of cardiac death was lower when patients were taking statin (adjusted HR, 0.64; 95% CI, 0.41–0.98; P = 0.041), which was clear only after 7 years. Both patients with CAD and on statin tended to undergo more AVR, but the difference was not statistically significant (the presence of established CAD; adjusted HR, 1.63; 95% CI, 0.51–3.51; P = 0.214 and the use of statin; adjusted HR, 1.86; 95% CI, 0.76–4.58; P = 0.177).
Conclusion: Mild to moderate AS does not have a benign course. The presence of CAD and statin use may affect the long-term prognosis of patients with mild to moderate AS.

참고문헌 (Reference)

1 Kodali SK, "Two-year outcomes after transcatheter or surgical aortic-valve replacement" 366 (366): 1686-1695, 2012

2 Eveborn GW, "The evolving epidemiology of valvular aortic stenosis. The Tromsø Study" 99 (99): 396-400, 2013

3 Moura LM, "Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis" 49 (49): 554-561, 2007

4 Rosenhek R, "Predictors of outcome in severe, asymptomatic aortic stenosis" 343 (343): 611-617, 2000

5 Pellikka PA, "Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up" 111 (111): 3290-3295, 2005

6 Rosenhek R, "Natural history of very severe aortic stenosis" 121 (121): 151-156, 2010

7 Kennedy KD, "Natural history of moderate aortic stenosis" 17 (17): 313-319, 1991

8 Rosenhek R, "Mild and moderate aortic stenosis. Natural history and risk stratification by echocardiography" 25 (25): 199-205, 2004

9 Aikawa E, "Look more closely at the valve : imaging calcific aortic valve disease" 125 (125): 9-11, 2012

10 Rossebø AB, "Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis" 359 (359): 1343-1356, 2008

11 Taniguchi T, "Initial surgical versus conservative strategies in patients with asymptomatic severe aortic stenosis" 66 (66): 2827-2838, 2015

12 Nadir MA, "Impact of renin-angiotensin system blockade therapy on outcome in aortic stenosis" 58 (58): 570-576, 2011

13 Bahler RC, "Factors leading to progression of valvular aortic stenosis" 84 (84): 1044-1048, 1999

14 Ureña P, "Evolutive aortic stenosis in hemodialysis patients : analysis of risk factors" 20 (20): 217-225, 1999

15 Novaro GM, "Effect of hydroxymethylglutaryl coenzyme a reductase inhibitors on the progression of calcific aortic stenosis" 104 (104): 2205-2209, 2001

16 Chan KL, "Effect of Lipid lowering with rosuvastatin on progression of aortic stenosis : results of the aortic stenosis progression observation : measuring effects of rosuvastatin(ASTRONOMER)trial" 121 (121): 306-314, 2010

17 Inki Moon, "Early Surgery versus Watchful Waiting in Patients with Moderate Aortic Stenosis and Left Ventricular Systolic Dysfunction" 대한심장학회 50 (50): 791-800, 2020

18 Mohler ER, "Development and progression of aortic valve stenosis : atherosclerosis risk factors--a causal relationship? A clinical morphologic study" 14 (14): 995-999, 1991

19 Dweck MR, "Calcific aortic stenosis : a disease of the valve and the myocardium" 60 (60): 1854-1863, 2012

20 Bellamy MF, "Association of cholesterol levels, hydroxymethylglutaryl coenzyme-A reductase inhibitor treatment, and progression of aortic stenosis in the community" 40 (40): 1723-1730, 2002

21 Otto CM, "Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly" 341 (341): 142-147, 1999

22 Otto CM, "Aortic-valve stenosis--from patients at risk to severe valve obstruction" 371 (371): 744-756, 2014

23 Otto CM, "Aortic stenosis : even mild disease is significant" 25 (25): 185-187, 2004

24 Cowell SJ, "A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis" 352 (352): 2389-2397, 2005

25 Catapano AL, "2016 ESC/EAS guidelines for the management of dyslipidaemias" 74 (74): 1234-1318, 2016

26 Nishimura RA, "2014 AHA/ACC guideline for the management of patients with valvular heart disease : executive summary : a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines" 129 (129): 2440-2492, 2014