Evaluation of the presence and extension valvular-related cardiac damage in patients with moderate aortic stenosis and its impact on outcomes

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Abstract Introduction and objective Echocardiographic measurements form the basis for diagnosing and determining the indication for therapy in aortic stenosis (AS). These measurements may vary depending on different patient-related and operator-related conditions. Recently, staging cardiac damage has emerged as a prognostic tool in asymptomatic and moderate to severe AS. We aim to evaluate the presence and severity of cardiac damage (1,2), and its impact on outcomes, in patients with a first diagnosis of moderate and severe AS. Methods A total of 119 patients undergoing transcatheter aortic valve replacement (TAVR) from November 2019 to January 2021 were included in a single-center retrospective registry. In each patient, the first echocardiogram establishing the diagnosis of moderate and severe AS was analysed. Results 119 patients with a mean age of 82.8±5.33 years (51% men) were included. At the first echo study with the diagnosis of moderate AS, mean pressure gradient was 23±9 mmHg, maximum pressure gradient was 42±15 mmHg, and mean aortic valve area was 1.13±0.41 cm2 (0.64±0.23 cm2/m2). Regarding cardiac damage, mean left ventricular ejection fraction was 65.4±10.4%, mean longitudinal global strain was -18.5±5.4%, and mean left atrial volume index was 41.6±31.2 mL/m2. 16% of patients have significant mitral regurgitation, and 10% right ventricular dysfunction. The mean progression time between moderate and severe diagnoses was 36 (2.4-175.2) months. Figure 1 shows the distribution of patients in different staging classification systems (1,2) at the time of diagnosis of moderate and severe AS. According to one of these staging classifications (1), 75.7% of patients had left-sided cardiac damage (Stages 1 and 2) and 16.8% had right-sided damage (Stages 3 and 4), without differences compared to the same patients when the stenosis became severe (p=0.194). On the contrary, following the most recent second classification (2), 63% had no significant cardiac damage (Stage 0), 31.1% of patients had left-sided cardiac damage (Stages 1 and 2) and 5.9% had right-sided damage (Stage 3), and this system showed better ability to discriminate between moderate and severe AS related-damage (p=0.002). The area under the ROC curve for one-year mortality after TAVR for the 2 staging systems applied at the moment of diagnosis of moderate and severe AS is presented in Figure 2. When used in moderate AS, it showed fair discrimination. However, the best model for predicting one-year mortality among those used, is the one used in the second classification (2) when the stenosis became severe. Conclusions AS-related cardiac damage may be present in early stages of AS and may help to guide the timing of intervention in selected patients. Staging classification of cardiac damage AUROC curve for one-year mortality

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