Valvular & structural heart disease
Predictors of outcome in patients with moderate mixed aortic valve disease
Authors' conclusion
Patients with truly moderate MAVD have a high incidence of death and heart failure hospitalisation (43% at 3.5 (2.5-4.7) years). Within this group, a high-risk group characterised by disproportionately low aortic Vmax (≤2.8 m/s) and adverse remodelling (LVEF ≤50%) have the worst outcomes.
Study context
- Population
- Patients with moderate mixed aortic stenosis and regurgitation (aortic valve area (AVA) 1.0–1.5 cm² and vena contracta (VC) 0.3–0.6 cm), diagnosed 2015–2019
- Participants
- 207 patients
- Outcome
- Composite of:
- Death
- HF hospitalisation
- Follow-up
- 3.5 (2.5-4.7) years
Methodological detailsmulticentre registry, consecutive patients
- Multicentre registry
- Consecutive patients
Main finding
As reported in the abstract
Death or HF hospitalisation; independent predictors (multivariable) · 3.5 (2.5-4.7) years
- Composite outcome incidence
- 89 patients (43%)
- Peak aortic jet velocity (Vmax), HR
- 0.63 (95% CI 0.43 to 0.93; p=0.021)
- Age, HR
- 1.05 (95% CI 1.03 to 1.08; p<0.001)
- Creatinine, HR
- 1.002 (95% CI 1.001 to 1.003; p=0.005)
- Previous cerebrovascular event (85% vs 42%), HR
- 3.04 (95% CI 1.54 to 5.99; p=0.001)
- Left ventricular ejection fraction (LVEF), HR
- 0.97 (95% CI 0.95 to 0.99; p=0.007)
Observational data: associations, not effects.
Further findings
| Outcome | Vmax ≤2.8 m/s and LVEF ≤50% | Rest of population | HR (95% CI) | P value | |
|---|---|---|---|---|---|
| Death or HF hospitalisation, Vmax ≤2.8 m/s and LVEF ≤50% (n=27)vs rest of population | 72% | 41% | 3.87 (2.20–6.80) | P < 0.001 | |
| 0.10.31310Hazard ratio (log scale) |
Univariable associations with primary outcome
- Older age, previous MI, previous cerebrovascular event, AF, NYHA >2, worse renal function, tricuspid regurgitation ≥2 and mitral regurgitation ≥2 associated with primary outcome
- Markers of biventricular systolic function, cardiac remodelling and transaortic valve haemodynamics inversely associated
Original publication
Predictors of outcome in patients with moderate mixed aortic valve disease. Heart. Published 26 December 2023. doi:10.
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