Associazione Nazionale Medici Cardiologi Ospedalieri

CONGRESS ABSTRACT

CONGRESS ABSTRACT

NATURAL HISTORY AND CLINICAL BURDEN OF MODERATE AORTIC STENOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Morelli Martina Milano (Milano) – Università Degli Studi Di Milano-Bicocca | Galasso Michele Milano (Milano) – Università Degli Studi Di Milano-Bicocca | Soriano Francesco Stefano Milano (Milano) – Asst Grande Ospedale Metropolitano Niguarda | Nava Stefano Milano (Milano) – Asst Grande Ospedale Metropolitano Niguarda | Da Pozzo Caterina Milano (Milano) – Università Degli Studi Di Milano | Esposito Giuseppe Milano (Milano) – Asst Grande Ospedale Metropolitano Niguarda | Piccaluga Emanuela Milano (Milano) – Asst Grande Ospedale Metropolitano Niguarda | Bossi Irene Milano (Milano) – Asst Grande Ospedale Metropolitano Niguarda | Montalto Claudio Milano (Milano) – Asst Grande Ospedale Metropolitano Niguarda | Oliva Francesco Giovanni Milano (Milano) – Asst Grande Ospedale Metropolitano Niguarda | Oreglia Jacopo Andrea Milano (Milano) – Asst Grande Ospedale Metropolitano Niguarda | Giannattasio Cristina Milano (Milano) – Università Degli Studi Di Milano-Bicocca; Asst Grande Ospedale Metropolitano Niguarda

OBJECTIVES: The aim of this study was to assess the natural history and clinical burden of moderate aortic stenosis and to investigate the interaction of left ventricular ejection fraction and of age with prognosis.

BACKGROUND: The mortality risk of patients with moderate aortic stenosis is not well known but recent studies suggested that it might negatively affect prognosis.

METHODS: A systematic research was conducted on PubMed. The inclusion criteria were: 1) inclusion of patients with moderate aortic stenosis; 2) report of the survival at 1-year follow-up (minimum). Incidence ratios related to all-cause mortality in patients and controls of each study were estimated and then pooled using a fixed effects model. Meta-regression analysis was performed to assess the impact of left ventricular ejection fraction and age on the prognosis of patients with moderate aortic stenosis.

RESULTS: Fifteen studies and 11,596 patients with moderate aortic stenosis were included. All-cause mortality was significantly higher among patients with moderate aortic stenosis than among controls: 10.7% (95% CI: 0.1010-0.1136) vs 4.5% (95% CI: 0.0438-0.0454) at 1-year (p < 0.0001), 17.7% (95% CI: 0.1692-0.1854) vs 7.6% (95% CI: 0.0754-0.0775) at 2-year, 23.0% (95% CI: 0.2204-0.2387) vs 9.9% (95% CI: 0.0973-0.0997) at 3-year, 27.9% (95% CI: 0.2685-0.2899) vs 11.9% (95% CI: 0.1177-0.1203) at 4-year, and 32.4% (95% CI: 0.3125-0.3360) vs 14.2% (95% CI: 0.1402-0.1430) at 5-year follow-up. Left ventricular ejection fraction did not significantly impact on the prognosis of patients with moderate aortic stenosis (estimate = -0.0020; 95% CI: -0.0078-0.0038; p = 0.4584), unlike of age (estimate = 0.0067; 95% CI: 0.0007-0.0127; p = 0.0323).

CONCLUSIONS: Moderate aortic stenosis is not a benign disease. Further studies are necessary to confirm the prognostic impact of this valvulopathy and the possible benefit of the aortic valve replacement.

Figure 1: All-cause mortality of patients with moderate aortic stenosis (red) vs controls (black) at 1-, 2-, 3-, 4- and 5-year follow-up.

Figure 2: Impact of left ventricular ejection fraction on prognosis of patients with moderate aortic stenosis.

Figure 3: Impact of age on prognosis of patients with moderate aortic stenosis.