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Contemporary presentation of patients with severe symptomatic aortic stenosis in the large IMPULSE multicenter registry from 23 centers across 9 European countries.

Session Poster session 4

Speaker Norbert Frey

Event : ESC Congress 2017

  • Topic : preventive cardiology
  • Sub-topic : Rehabilitation: Outcomes
  • Session type : Poster Session

Authors : N Frey (Kiel,DE), RP Steeds (Birmingham,GB), S Baldus (Cologne,DE), E Schulz (Mainz,DE), A Serra (Barcelona,ES), M Lutz (Kiel,DE), C Pohlmann (Mahlow,DE), J Kurucova (Nyon,CH), P Bramlage (Mahlow,DE), D Messika-Zeitoun (Paris,FR)

Authors:
N. Frey1 , R.P. Steeds2 , S. Baldus3 , E. Schulz4 , A. Serra5 , M. Lutz1 , C. Pohlmann6 , J. Kurucova7 , P. Bramlage8 , D. Messika-Zeitoun9 , 1University Medical Center of Schleswig-Holstein, Department of Cardiology and Angiology - Kiel - Germany , 2Queen Elizabeth Hospital Birmingham - Birmingham - United Kingdom , 3Cologne University Hospital - Heart Center, Clinic of Cardiology, Angiology and Pneumology and Intensive Care Medicine - Cologne - Germany , 4University Medical Center of Mainz, Department of Internal Medicine I - Mainz - Germany , 5Hospital de Santa Creu I Sant Pau, Department of Cardiology - Barcelona - Spain , 6Institute for Pharmacology and Preventive Medicine - Mahlow - Germany , 7Edwards Lifesciences - Nyon - Switzerland , 8Institute for Cardiovascular Pharmacology and Epidemiology - Mahlow - Germany , 9Hospital Bichat-Claude Bernard, Department of Cardiology - Paris - France ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 715

Background: Severe aortic stenosis (AS) is a life-threatening disease with a survival below 40–60% at 5 years following the onset of symptoms. The Euro Heart Survey found that many patients with VHD presented at an advanced age with severe symptoms and multiple co-morbidities, and that 31% did not proceed with intervention but these data are now more than 15 years old. Given the changing practice in this field, there is a need for contemporary data on the characteristics of patients with AS.

Purpose: The aim of the IMPULSE registry was to define contemporary characteristics of consecutive patients diagnosed with severe AS on echocardiography in tertiary hospitals throughout Europe.

Methods: Prospective, multicentre, multi-national echo-lab based registry across 23 centres in 9 countries. Centre inclusion was based on the availability of an on-site heart team and a capacity for both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI).

Results: A total of 1925 patient were enrolled since March 2015 up to December 2016. Patients were aged 78.1±9.9 years (83.6% ≥70 years) and 48.3% were female. A total of 80.8% were symptomatic with 41.4% being classified as NYHA class III or IV. Angina CCS class III or IV was reported in 4.9% of patients. Frailty was common, with 34.1% classified as mild, and 5.2% severe.

The mean EuroSCORE II was 4.2±5.7% (EuroSCORE II >10%: 8.8% of patients). Important comorbidities were chronic lung disease in 10.8%, pulmonary hypertension (>55 mmHg) in 10.6% and diabetes mellitus (using insulin) in 9.0%. Additional characteristics included renal impairment (creatinine clearance <50 ml/min: 27.2%), poor mobility (22.6%), previous cardiac surgery (6.9%), recent myocardial infarction (3.0%), and liver disease (2.2%).

Left ventricular ejection fraction was 56.1±12.4% (26.4% had an EF of <50%). The mean aortic pressure gradient was 46.9±14.6 mmHg and the aortic valve area (AVA) 0.73±0.19 cm2. There was documented concomitant moderate or severe aortic regurgitation in 8.8%, mitral regurgitation in 10.7%, tricuspid regurgitation in 8.0%, and mitral stenosis in 1.7% of patients.

Conclusion: This prospective survey provides unique contemporary data on characteristics of European patients diagnosed with severe AS on echocardiography. Patients are on average more than 10 years older than those in the Euro Heart Survey, have more extensive comorbidities, and many still present late with advanced symptoms. More should be done to screen and identify patients with AS at an earlier stage but in the era of TAVI, these data have important implications for therapeutic strategies.

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