JACC. Advances · 2025
The Association of Aortic Stenosis Severity and Symptom Status With Morbidity and Mortality.
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Solomon Matthew D, Go Alan S, Leong Thomas, Garcia Elisha, Le Kathy, Philip Femi, McNulty Edward, Mishell Jacob, Rassi Andrew N, Lange David C, Lee Catherine, DeMaria Anthony, Nishimura Rick, Ambrosy Andrew P
Аннотация
BACKGROUND: The relationship between aortic stenosis (AS) severity, AS-related symptoms, and clinical outcomes is poorly understood.
OBJECTIVES: The purpose of this study was to evaluate whether potential AS-related symptoms at diagnosis are associated with outcomes, including death and AS-related hospitalization.
METHODS: In this retrospective cohort study from a large, integrated health care system serving >4.5 M individuals, we applied validated natural language processing algorithms to echocardiogram reports to identify physician-assessed AS severity and potential AS-related symptoms (eg, chest pain, syncope, dyspnea, worsening heart failure) via diagnosis codes and natural language processing-applied physician notes. Of 602,821 adults with echocardiograms from 2010 to 2019, we identified 40,333 adults diagnosed with AS and applied Cox models to examine associations between AS-related symptoms, AS severity, and clinical outcomes over a median follow-up of 2.2 years.
RESULTS: Most patients with AS had potential AS-related symptoms (mild: 80%, mild-moderate: 77%, moderate: 77%, moderate-severe: 85%, severe: 87%). Symptomatic patients were older (mean age 78 vs 75 years; P < 0.01), more often female (51% vs 47%; P < 0.01), and had greater comorbidity burden. After multivariable adjustment, symptom status strongly predicted risk. Patients with symptomatic moderate AS had a similar risk to those with severe AS without symptoms (adjusted HR: 1.77 [95% CI: 1.65-1.91] vs 1.81 [95% CI: 1.51-2.17] for death, P = 0.81; aHR: 2.27 [95% CI: 2.13-2.41] vs 2.40 [95% CI: 2.08-2.77] for AS-related hospitalization, P = 0.42).
CONCLUSIONS: These findings suggest that symptom status, independent of AS severity, is a key risk factor for adverse outcomes. Further research is needed to assess the benefits of early intervention in these high-risk groups.
OBJECTIVES: The purpose of this study was to evaluate whether potential AS-related symptoms at diagnosis are associated with outcomes, including death and AS-related hospitalization.
METHODS: In this retrospective cohort study from a large, integrated health care system serving >4.5 M individuals, we applied validated natural language processing algorithms to echocardiogram reports to identify physician-assessed AS severity and potential AS-related symptoms (eg, chest pain, syncope, dyspnea, worsening heart failure) via diagnosis codes and natural language processing-applied physician notes. Of 602,821 adults with echocardiograms from 2010 to 2019, we identified 40,333 adults diagnosed with AS and applied Cox models to examine associations between AS-related symptoms, AS severity, and clinical outcomes over a median follow-up of 2.2 years.
RESULTS: Most patients with AS had potential AS-related symptoms (mild: 80%, mild-moderate: 77%, moderate: 77%, moderate-severe: 85%, severe: 87%). Symptomatic patients were older (mean age 78 vs 75 years; P < 0.01), more often female (51% vs 47%; P < 0.01), and had greater comorbidity burden. After multivariable adjustment, symptom status strongly predicted risk. Patients with symptomatic moderate AS had a similar risk to those with severe AS without symptoms (adjusted HR: 1.77 [95% CI: 1.65-1.91] vs 1.81 [95% CI: 1.51-2.17] for death, P = 0.81; aHR: 2.27 [95% CI: 2.13-2.41] vs 2.40 [95% CI: 2.08-2.77] for AS-related hospitalization, P = 0.42).
CONCLUSIONS: These findings suggest that symptom status, independent of AS severity, is a key risk factor for adverse outcomes. Further research is needed to assess the benefits of early intervention in these high-risk groups.