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Impact of selected comorbidities on the presentation and management of aortic stenosis

TK. Rudolph, D. Messika-Zeitoun, N. Frey, J. Thambyrajah, A. Serra, E. Schulz, J. Maly, M. Aiello, G. Lloyd, AS. Bortone, A. Clerici, G. Delle-Karth, J. Rieber, C. Indolfi, M. Mancone, L. Belle, A. Lauten, M. Arnold, BJ. Bouma, M. Lutz, C....

. 2020 ; 7 (2) : . [pub] -

Language English Country Great Britain

Document type Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't

Persistent link   https://www.medvik.cz/link/bmc20028067

BACKGROUND: Contemporary data regarding the impact of comorbidities on the clinical presentation and management of patients with severe aortic stenosis (AS) are scarce. METHODS: Prospective registry of severe patients with AS across 23 centres in nine European countries. RESULTS: Of the 2171 patients, chronic kidney disease (CKD 27.3%), left ventricular ejection fraction (LVEF) <50% (22.0%), atrial fibrillation (15.9%) and chronic obstructive pulmonary disease (11.4%) were the most prevalent comorbidities (49.3% none, 33.9% one and 16.8% ≥2 of these). The decision to perform aortic valve replacement (AVR) was taken in a comparable proportion (67%, 72% and 69%, in patients with 0, 1 and ≥2 comorbidities; p=0.186). However, the decision for TAVI was more common with more comorbidities (35.4%, 54.0% and 57.0% for no, 1 and ≥2; p<0.001), while the decision for surgical AVR (SAVR) was decreased with increasing comorbidity burden (31.9%, 17.4% and 12.3%; p<0.001). The proportion of patients with planned AVRs that were performed within 3 months was significantly higher in patients with 1 or ≥2 comorbidities than in those without (8.7%, 10.0% and 15.7%; p<0.001). Furthermore, the mean time to AVR was significantly shorter in patients with one (30.5 days) or ≥2 comorbidities (30.8 days) than in those without (35.7 days; p=0.012). Patients with reduced LVEF tended to be offered an AVR more frequently and with a shorter delay while patients with CKD were less frequently treated. CONCLUSIONS: Comorbidities in severe patients with AS affect the presentation and management of patients with severe AS. TAVI was offered more often than SAVR and performed within a shorter time period.

4th Medical Department Hietzing Hospital Vienna Austria

Cardiology Department AKH Celle Celle Germany

Centre Hospital d'Annecy Annecy France

Department of Cardiology and Angiology University of Kiel Kiel Germany

Department of Cardiology Heart and Diabetes Center Bad Oeynhausen Ruhr University of Bochum Bad Oeynhausen Germany

Department of Cardiology University of Erlangen Erlangen Germany

Department of Cardiothoracic Surgery Foundation IRCCS Policlinico S Matteo Pavia Italy

Department of Cardiovascular Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic Department of Cardiovascular Surgery 2nd Faculty of Medicine Charles University Prague Czech Republic

Division of Cardiology and URT CNR of IFC Magna Graecia University Catanzaro Italy

Edwards Lifesciences Nyon Switzerland

Edwards Lifesciences Prague Czech Republic

German Centre for Cardiovascular Research University Heart Center and Charité Berlin Germany

Herzkatheterlabor Nymphenburg and Department of Cardiology University of Munich Munich Germany

Institute for Pharmacology and Preventive Medicine Cloppenburg Germany

Interventional Cardiology Unit Hospital de la Santa Creu i Sant Pau Barcelona Spain

James Cook University Hospital Middlesbrough Middlesbrough UK

Queen Elizabeth Hospital and Institute of Cardiovascular Sciences University of Birmingham Birmingham UK

Sapienza University of Rome Rome Italy

St Bartholomew's Hospital London UK

University of Amsterdam Amsterdam Netherlands

University of Bari Bari Italy

University of Ottawa Heart Institute Ottawa Ontario Canada

University of Turin Turin Italy

References provided by Crossref.org

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$a Rudolph, Tanja K $u Department of Cardiology, Heart and Diabetes Center Bad Oeynhausen, Ruhr-University of Bochum, Bad Oeynhausen, Germany tk.rudolph@me.com.
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$a Impact of selected comorbidities on the presentation and management of aortic stenosis / $c TK. Rudolph, D. Messika-Zeitoun, N. Frey, J. Thambyrajah, A. Serra, E. Schulz, J. Maly, M. Aiello, G. Lloyd, AS. Bortone, A. Clerici, G. Delle-Karth, J. Rieber, C. Indolfi, M. Mancone, L. Belle, A. Lauten, M. Arnold, BJ. Bouma, M. Lutz, C. Deutsch, J. Kurucova, M. Thoenes, P. Bramlage, RP. Steeds,
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$a BACKGROUND: Contemporary data regarding the impact of comorbidities on the clinical presentation and management of patients with severe aortic stenosis (AS) are scarce. METHODS: Prospective registry of severe patients with AS across 23 centres in nine European countries. RESULTS: Of the 2171 patients, chronic kidney disease (CKD 27.3%), left ventricular ejection fraction (LVEF) <50% (22.0%), atrial fibrillation (15.9%) and chronic obstructive pulmonary disease (11.4%) were the most prevalent comorbidities (49.3% none, 33.9% one and 16.8% ≥2 of these). The decision to perform aortic valve replacement (AVR) was taken in a comparable proportion (67%, 72% and 69%, in patients with 0, 1 and ≥2 comorbidities; p=0.186). However, the decision for TAVI was more common with more comorbidities (35.4%, 54.0% and 57.0% for no, 1 and ≥2; p<0.001), while the decision for surgical AVR (SAVR) was decreased with increasing comorbidity burden (31.9%, 17.4% and 12.3%; p<0.001). The proportion of patients with planned AVRs that were performed within 3 months was significantly higher in patients with 1 or ≥2 comorbidities than in those without (8.7%, 10.0% and 15.7%; p<0.001). Furthermore, the mean time to AVR was significantly shorter in patients with one (30.5 days) or ≥2 comorbidities (30.8 days) than in those without (35.7 days; p=0.012). Patients with reduced LVEF tended to be offered an AVR more frequently and with a shorter delay while patients with CKD were less frequently treated. CONCLUSIONS: Comorbidities in severe patients with AS affect the presentation and management of patients with severe AS. TAVI was offered more often than SAVR and performed within a shorter time period.
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$a Messika-Zeitoun, David $u University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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$a Lutz, Matthias $u Department of Cardiology and Angiology, University of Kiel, Kiel, Germany.
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