In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

The free consultation period for this content is over.

It is now only available year-round to ESC Professional Members, Fellows of the ESC, and Young combined Members

Non-severe aortic stenosis as a predictor of major cardiac events in patients referred for exercise echocardiography

Session Poster session 1

Speaker Jesus Carlos Peteiro Vazquez

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : J C Peteiro Vazquez (A Coruna,ES), A Bouzas-Mosquera (A Coruna,ES), F Broullon (A Coruna,ES), V Mosquera (A Coruña,ES), JM Vazquez-Rodriguez (A Coruna,ES)

Authors:
J.C. Peteiro Vazquez1 , A. Bouzas-Mosquera1 , F. Broullon2 , V. Mosquera3 , J.M. Vazquez-Rodriguez1 , 1University Hospital A Coruna, Dept. of Cardiology - A Coruna - Spain , 2University Hospital A Coruna, Dept. of Information Technology - A Coruna - Spain , 3University Hospital A Coruña, Cardiac Surgery - A Coruña - Spain ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 200

Patients with aortic stenosis (AS) referred for exercise echocardiography (ExE) might have worse outcome. We aimed to assess the impact of non-severe AS on outcome in patients with a clinically indicated ExE study.

Methods: Retrospective analysis of prospectively collected data on 12,615 patients with a first treadmill ExE performed in our center. Exclusion criteria were ≥moderate aortic regurgitation, significant mitral valve disease, cardiomyopathy, congenital heart disease, and age <18 year-old. Ischemia was defined as a Δ in wall motion score index (WMSI) from rest to exercise; abnormal ExE as exercise WMSI>1.0. End points were major cardiac events (MACE) defined as cardiac death or non-fatal myocardial infarction or aortic valve replacement (AVR), either before any revascularization procedure; and overall mortality.

Results: A total of 330 patients had AS (2.6%; mild in 190, moderate in 140). Patients with AS had worse clinical characteristics (higher age, prevalence of coronary risk factors, % with typical angina, atrial fibrillation, abnormal resting ECG, history of coronary disease, and taking cardiovascular medications) and worse exercise testing characteristics (lower systolic blood pressure and heart rate at exercise, less achieved workload, and more frequency of symptoms and positive ECG) than those without AS. ExE showed more frequently abnormal ExE results and ischemia in those with AS (53% vs. 42%; and 47% vs. 30%; both p<0.001). Left ventricular ejection fraction and WMSI at peak exercise were also worse in them (59±14 vs. 62±13, p<0.001; and 1.29±0.39 vs. 1.22±0.34, p=0.001). During follow-up (Median 3.2 years, 25–75th percentiles=0.12–8.0 years) there were 1,394 MACE and 2,575 deaths. The annualized MACE rates were 17.0% in moderate AS, 6.5% in mild AS, and 2.8% without AS (p<0.001). After adjustment for clinical characteristics and resting and exercise echocardiography, the presence of AS was an independent predictor of MACE (Hazard ratio [HR]=1.99, 95% Confidence Interval [CI]=1.77–2.24, p<0.001). Any of the exercise echocardiography variables increased further the power of the model for predicting MACE: ΔLVEF, peak LVEF, ΔWMSI, ischemia, and abnormal (all p<0.001). AS was also an univariate predictor of mortality (HR=1.28, 95% CI=1.13–1.44, p<0.001), although it was not after adjustment.

In conclusion, patients with symptomatic non-severe AS have more frequently abnormal ExE studies and are at a higher risk of major cardiac events. The presence of non-severe AS is an independent predictor of events in patients referred for ExE.

The free consultation period for this content is over.

It is now only available year-round to ESC Professional Members, Fellows of the ESC, and Young combined Members

Members get more

Join now
  • 1ESC Professional Members – access all resources from general ESC events 
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s resources
  • 3Under 40 or in training - with a Combined Membership, access all resources
Join now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are