Open heart · 2020
Impact of selected comorbidities on the presentation and management of aortic stenosis.
СтатьяМногоцентровое исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Rudolph Tanja K, Messika-Zeitoun David, Frey Norbert, Thambyrajah Jeetendra, Serra Antonio, Schulz Eberhard, Maly Jiri, Aiello Marco, Lloyd Guy, Bortone Alessandro Santo, Clerici Alberto, Delle-Karth Georg, Rieber Johannes, Indolfi Ciro, Mancone Massimo, Belle Loic, Lauten Alexander, Arnold Martin, Bouma Berto J, Lutz Matthias, Deutsch Cornelia, Kurucova Jana, Thoenes Martin, Bramlage Peter, Steeds Richard P
Аннотация
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.
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.
Предметные рубрики MeSH
AgedAged, 80 and overAortic Valve StenosisAtrial FibrillationClinical Decision-MakingComorbidityEuropeFemaleHeart Valve Prosthesis ImplantationHumansMalePrevalenceProspective StudiesPulmonary Disease, Chronic ObstructiveRegistriesRenal Insufficiency, ChronicRisk AssessmentRisk FactorsSeverity of Illness IndexStroke VolumeTime FactorsTime-to-TreatmentTranscatheter Aortic Valve ReplacementTreatment OutcomeVentricular Function, Left