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Score devised to predict outcomes in asymptomatic patients with aortic stenosis
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A novel clinical score using factors related to midwall myocardial fibrosis predicted poor outcomes in patients with asymptomatic aortic stenosis, according to findings published in the European Heart Journal.
The score could be used to identify patients who are high risk despite lack of symptoms and could benefit from early valve replacement, the researchers wrote.
Using cardiac MRI, Calvin W.L. Chin, MD, and colleagues determined midwall fibrosis in 147 patients (mean age, 70 years; 68% men; median peak aortic velocity, 3.9 m/s; interquartile range, 3.2-4.4).
They then developed a multivariate logistic score based on routine clinical variables that were significantly associated with midwall fibrosis, which previous research identified as a marker of early ventricular decompensation and a potential predictor for poor outcomes related to aortic stenosis.
The score — which includes age, sex, log-transformed high-sensitivity plasma cardiac troponin I concentration, log-transformed peak aortic velocity and ECG strain — showed good discrimination (C-statistic = 0.85; 95% CI, 0.78-0.91; P < .001) and calibration (Hosmer–Lemeshow test = 7.3; P = .5), according to the researchers.
Chin, from British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Scotland, and colleagues tested the score’s prognostic value in an internal cohort (n = 127; median follow-up, 10.3 years; interquartile range, 5.7-11.2) and an external cohort (n = 289; median follow-up, 2.6 years; interquartile range, 1.6-4.5) of patients with asymptomatic aortic stenosis.
The primary outcome was a composite of CV death, HF and new angina/dyspnea/syncope, all of which could be related to aortic stenosis.
In both cohorts, the patients were classified as low risk (probability score < 7%), intermediate risk (probability score 7% to 57%) or high risk (probability score > 57%).
Chin and colleagues found that in both cohorts, event rates were much higher in the high-risk group than in the low-risk group (internal cohort: 23.9 events/100 patient-years vs. 2.1 events/100 patient-years; log rank P < .001; external cohort: 31.6 events/100 patient-years vs. 4.6 events/100 patient-years; log rank P < .001).
“Our observations have indirectly strengthened the prognostic association between [cardiac MR] midwall fibrosis and [CV] outcomes,” they wrote. “Potentially, asymptomatic patients with advanced [aortic stenosis] can initially be stratified using this clinical score. Patients at low risk can be managed conservatively with regular reassessment of risk, while those at high risk (particularly those with severe [aortic stenosis]) can be considered for early [aortic valve replacement]. Finally, patients with intermediate-risk scores can undergo further risk stratification.” – by Erik Swain
Disclosure: Chin reports no relevant financial disclosures. Three other researchers report financial ties with Abbott and Beckman Coulter.
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