Sadie Bennett, Eric Holroyd, Maria F Paton, Paul Leeson, Bjorn Redfors, Philippe Pibarot, Philippe Généreux, Chun Shing Kwok
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The main outcome of interest were proportion of AS patients with signs of cardiac damage, all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events.</p><p><strong>Results: </strong>A total of 18 studies were included with 21,876 patients (mean age 79 years, 52.7% males). Pooled analysis indicated 76% of symptomatic severe AS patients and 88% of asymptomatic moderate/severe AS patients had signs of cardiac damage, with stage two being the most commonly reported (25.1% and 32.3% respectively). For symptomatic severe AS patients, the pooled all-cause mortality and cardiovascular mortality rates increased along an increase in cardiac damage stage from 9.4% to 2.0% respectively for stage 0 to 24.2% and 36.1% respectively for stage 4. In patients with asymptomatic moderate / severe AS, all-cause mortality ranged from 30.0% in stage 0 to 51.2% in stage 3/4. In patients with symptomatic severe AS undergoing AVR, meta-analysis indicated an increase in odds of cardiovascular related mortality for stage 4 cardiac damage only (OR 6.89, 95% CI: 3.04,15.61, p = 0.003). An increased odds of all-cause mortality was seen in for cardiac damage stages 1, 3 and 4 (OR 1.4, 95%CI: 1.10,1.77, p = 0.01, OR 2.27, 95%CI: 1.76,2.92, p = 0.0002 and OR 2.94, 95%CI: 1.97,4.38, p = 0.0006 respectively).</p><p><strong>Conclusions: </strong>Cardiac damage is a common finding amongst patients with AS irrespective of AS severity or symptomatic status. Mortality rates appear to increase alongside an increase in cardiac damage staging. Cardiac damage may provide prognostic valve when considering the timing of AVR with left ventricular and right ventricular abnormalities being associated with increased odds of mortality.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":45749,"journal":{"name":"Echo Research and Practice","volume":"12 1","pages":"29"},"PeriodicalIF":2.4000,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482353/pdf/","citationCount":"0","resultStr":"{\"title\":\"The value of evaluating cardiac damage in patients with aortic stenosis: a systematic review and meta-analysis.\",\"authors\":\"Sadie Bennett, Eric Holroyd, Maria F Paton, Paul Leeson, Bjorn Redfors, Philippe Pibarot, Philippe Généreux, Chun Shing Kwok\",\"doi\":\"10.1186/s44156-025-00089-w\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Aortic stenosis (AS) is a common valvular heart disease where aortic valve replacement (AVR) is the only treatment. A novel staging system based on cardiac damage was developed to assess the pathophysiological consequence of AS and this has been shown to be associated with outcomes post AVR.</p><p><strong>Methods: </strong>We conducted a systematic review of studies which evaluated cardiac damage in patients with AS. A search of MEDLINE and EMBASE was performed with data being extracted from relevant studies. The main outcome of interest were proportion of AS patients with signs of cardiac damage, all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events.</p><p><strong>Results: </strong>A total of 18 studies were included with 21,876 patients (mean age 79 years, 52.7% males). Pooled analysis indicated 76% of symptomatic severe AS patients and 88% of asymptomatic moderate/severe AS patients had signs of cardiac damage, with stage two being the most commonly reported (25.1% and 32.3% respectively). For symptomatic severe AS patients, the pooled all-cause mortality and cardiovascular mortality rates increased along an increase in cardiac damage stage from 9.4% to 2.0% respectively for stage 0 to 24.2% and 36.1% respectively for stage 4. In patients with asymptomatic moderate / severe AS, all-cause mortality ranged from 30.0% in stage 0 to 51.2% in stage 3/4. In patients with symptomatic severe AS undergoing AVR, meta-analysis indicated an increase in odds of cardiovascular related mortality for stage 4 cardiac damage only (OR 6.89, 95% CI: 3.04,15.61, p = 0.003). An increased odds of all-cause mortality was seen in for cardiac damage stages 1, 3 and 4 (OR 1.4, 95%CI: 1.10,1.77, p = 0.01, OR 2.27, 95%CI: 1.76,2.92, p = 0.0002 and OR 2.94, 95%CI: 1.97,4.38, p = 0.0006 respectively).</p><p><strong>Conclusions: </strong>Cardiac damage is a common finding amongst patients with AS irrespective of AS severity or symptomatic status. 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引用次数: 0
摘要
背景：主动脉瓣狭窄（AS）是一种常见的瓣膜性心脏病，主动脉瓣置换术（AVR）是唯一的治疗方法。一种基于心脏损伤的新型分期系统被开发出来，以评估AS的病理生理后果，这已被证明与AVR后的结果相关。方法：我们对评估AS患者心脏损伤的研究进行了系统回顾。检索MEDLINE和EMBASE，并从相关研究中提取数据。研究的主要结局是有心脏损伤迹象的AS患者比例、全因死亡率、心血管死亡率和主要不良心血管事件。结果：共纳入18项研究，21876例患者（平均年龄79岁，男性52.7%）。合并分析显示，76%的有症状的重度AS患者和88%的无症状的中/重度AS患者有心脏损伤的迹象，其中二期最为常见（分别为25.1%和32.3%）。对于有症状的严重AS患者，全因死亡率和心血管死亡率随着心脏损伤分期的增加而增加，从0期的9.4%分别增加到2.0%，到4期的24.2%和36.1%。无症状中/重度AS患者的全因死亡率从0期的30.0%到3/4期的51.2%不等。在接受AVR治疗的有症状的严重AS患者中，荟萃分析显示，仅4期心脏损伤的心血管相关死亡率增加（OR 6.89, 95% CI: 3.04,15.61, p = 0.003）。心脏损伤1、3、4期全因死亡率增加（OR 1.4, 95%CI: 1.10、1.77,p = 0.01; OR 2.27, 95%CI: 1.76、2.92,p = 0.0002; OR 2.94, 95%CI: 1.97、4.38,p = 0.0006）。结论：心脏损伤在AS患者中是一种常见的发现，与AS的严重程度或症状状态无关。死亡率似乎随着心脏损伤分期的增加而增加。当考虑到左室和右室异常与死亡率增加相关的AVR时间时，心脏损伤可能提供预后阀。临床试验号：不适用。
The value of evaluating cardiac damage in patients with aortic stenosis: a systematic review and meta-analysis.
Background: Aortic stenosis (AS) is a common valvular heart disease where aortic valve replacement (AVR) is the only treatment. A novel staging system based on cardiac damage was developed to assess the pathophysiological consequence of AS and this has been shown to be associated with outcomes post AVR.
Methods: We conducted a systematic review of studies which evaluated cardiac damage in patients with AS. A search of MEDLINE and EMBASE was performed with data being extracted from relevant studies. The main outcome of interest were proportion of AS patients with signs of cardiac damage, all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events.
Results: A total of 18 studies were included with 21,876 patients (mean age 79 years, 52.7% males). Pooled analysis indicated 76% of symptomatic severe AS patients and 88% of asymptomatic moderate/severe AS patients had signs of cardiac damage, with stage two being the most commonly reported (25.1% and 32.3% respectively). For symptomatic severe AS patients, the pooled all-cause mortality and cardiovascular mortality rates increased along an increase in cardiac damage stage from 9.4% to 2.0% respectively for stage 0 to 24.2% and 36.1% respectively for stage 4. In patients with asymptomatic moderate / severe AS, all-cause mortality ranged from 30.0% in stage 0 to 51.2% in stage 3/4. In patients with symptomatic severe AS undergoing AVR, meta-analysis indicated an increase in odds of cardiovascular related mortality for stage 4 cardiac damage only (OR 6.89, 95% CI: 3.04,15.61, p = 0.003). An increased odds of all-cause mortality was seen in for cardiac damage stages 1, 3 and 4 (OR 1.4, 95%CI: 1.10,1.77, p = 0.01, OR 2.27, 95%CI: 1.76,2.92, p = 0.0002 and OR 2.94, 95%CI: 1.97,4.38, p = 0.0006 respectively).
Conclusions: Cardiac damage is a common finding amongst patients with AS irrespective of AS severity or symptomatic status. Mortality rates appear to increase alongside an increase in cardiac damage staging. Cardiac damage may provide prognostic valve when considering the timing of AVR with left ventricular and right ventricular abnormalities being associated with increased odds of mortality.
期刊介绍：
Echo Research and Practice aims to be the premier international journal for physicians, sonographers, nurses and other allied health professionals practising echocardiography and other cardiac imaging modalities. This open-access journal publishes quality clinical and basic research, reviews, videos, education materials and selected high-interest case reports and videos across all echocardiography modalities and disciplines, including paediatrics, anaesthetics, general practice, acute medicine and intensive care. Multi-modality studies primarily featuring the use of cardiac ultrasound in clinical practice, in association with Cardiac Computed Tomography, Cardiovascular Magnetic Resonance or Nuclear Cardiology are of interest. Topics include, but are not limited to: 2D echocardiography 3D echocardiography Comparative imaging techniques – CCT, CMR and Nuclear Cardiology Congenital heart disease, including foetal echocardiography Contrast echocardiography Critical care echocardiography Deformation imaging Doppler echocardiography Interventional echocardiography Intracardiac echocardiography Intraoperative echocardiography Prosthetic valves Stress echocardiography Technical innovations Transoesophageal echocardiography Valve disease.
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