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Prevalence and prognostic impact of comorbidities in patients with severe aortic valve stenosis

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Summary

In patients with severe aortic valve stenosis (valve area ≤ 1 cm2, AS), the prevalence and the prognostic impact of comorbidities is unknown. Fifty-eight patients with severe AS (mean aortic valve area 0.8 ± 0.2 cm2), who underwent cardiac catheterization and 2-D/Doppler echocardiography, were prospectively enrolled. The glomerular filtration rate (eGFR) was estimated using the abbreviated Modification of Diet in Renal Disease Study equation. Death from a cardiac cause was defined as study end point.

Coronary artery disease was present in 33 patients (57%). Subsequently, 43 patients (77%) underwent aortic valve replacement. During a follow-up of 485 ± 336 days, 11 patients suffered a cardiac death. Survivors and non-survivors did not differ with respect the prevalence of coronary artery disease, invasive hemodynamic measurements or echocardiographic variables of systolic/diastolic function. Non-survivors were in a poorer NYHA functional class (3.2 ± 0.3 vs 2.4±0.8, p = 0.002), had a lower eGFR (33.4 ± 15.5 ml/min/1.73 m2 vs 49.1 ± 15.6 ml/min/1.73m2, p = 0.004), a higher prevalence of diabetes mellitus (73% vs. 22%, p = 0.0001) and a lower serum hemoglobin level (11.6 ± 2.1 vs 13.0 ± 1.5 g/dL, p = 0.017). By multivariate Cox analysis, NYHA class (hazard ratio: 6.17, p = 0.013) and eGFR (hazard ratio 0.95, p = 0.04) were independent prognostic predictors. In patients with eGFR < 41.8 ml/min/1.73 m2 (cut-off value derived from ROC analysis, area under the curve: 0.78 ± 0.08), outcome was markedly poorer as compared to patients with eGFR > 41.8 ml/min/1.73 m2 (event-free survival rate of 38% vs 93%, p = 0.004). Thus, in patients with severe AS, comorbidities are frequent, and particularly kidney disease significantly impacts longterm outcome.

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Authors and Affiliations

  1. Universitätsklinikum Münster, Medizinische Klinik und Poliklinik C (Kardiologie und Angiologie), Albert-Schweitzer-Str. 33, 48129, Münster, Germany

    Christian Bruch MD, Daniela Kauling, Holger Reinecke MD, PhD, Markus Rothenburger MD, PhD, Hans Heinrich Scheld MD, PhD, Günter Breithardt MD, PhD & Thomas Wichter MD, PhD

  2. Department of Thoracic and Cardiovascular Surgery, Hospital of the University of Münster, Münster, Germany

    Markus Rothenburger MD, PhD

Authors
  1. Christian Bruch MD
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  2. Daniela Kauling
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  3. Holger Reinecke MD, PhD
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  4. Markus Rothenburger MD, PhD
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  5. Hans Heinrich Scheld MD, PhD
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  6. Günter Breithardt MD, PhD
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  7. Thomas Wichter MD, PhD
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Correspondence to Christian Bruch MD.

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Bruch, C., Kauling, D., Reinecke, H. et al. Prevalence and prognostic impact of comorbidities in patients with severe aortic valve stenosis. Clin Res Cardiol 96, 23–29 (2007). https://doi.org/10.1007/s00392-006-0452-1

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  • DOI: https://doi.org/10.1007/s00392-006-0452-1

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