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Meta-Analysis
. 2022 Aug 22;15(16):1664-1674.
doi: 10.1016/j.jcin.2022.06.022.

Impact of Moderate Aortic Stenosis on Long-Term Clinical Outcomes: A Systematic Review and Meta-Analysis

Augustin Coisne  1 , Andrea Scotti  2 , Azeem Latib  3 , David Montaigne  4 , Edwin C Ho  3 , Sebastian Ludwig  5 , Thomas Modine  6 , Philippe Généreux  7 , Jeroen J Bax  8 , Martin B Leon  9 , Christophe Bauters  10 , Juan F Granada  9
Affiliations
Free article
Meta-Analysis

Impact of Moderate Aortic Stenosis on Long-Term Clinical Outcomes: A Systematic Review and Meta-Analysis

Augustin Coisne et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: The clinical course of patients with moderate aortic stenosis (AS) remains incompletely defined.

Objectives: This study sought to analyze the clinical course of moderate AS and compare it with other stages of the disease.

Methods: Multiple electronic databases were searched to identify studies on adult moderate AS. Random-effects models were used to derive pooled estimates. The primary endpoint was all-cause death. The secondary endpoints were cardiac death, heart failure, sudden death, and aortic valve replacement.

Results: Among a total of 25 studies (12,143 moderate AS patients, 3.7 years of follow-up), pooled rates per 100 person-years were 9.0 (95% CI: 6.9 to 11.7) for all-cause death, 4.9 (95% CI: 3.1 to 7.5) for cardiac death, 3.9 (95% CI: 1.9 to 8.2) for heart failure, 1.1 (95% CI: 0.8 to 1.5) for sudden death, and 7.2 (95% CI: 4.3 to 12.2) for aortic valve replacement. Meta-regression analyses detected that diabetes (P = 0.019), coronary artery disease (P = 0.017), presence of symptoms (P < 0.001), and left ventricle (LV) dysfunction (P = 0.009) were associated with a significant impact on the overall estimate of all-cause death. All-cause mortality was higher in patients with reduced LV ejection fraction (<50%) than with normal LV ejection fraction: 16.5 (95% CI: 5.2 to 52.3) and 4.2 (95% CI: 1.4 to 12.8) per 100 person-years, respectively. Compared with moderate AS, the incidence rate difference of all-cause mortality was -3.9 (95% CI: -6.7 to -1.1) for no or mild AS and +2.2 (95% CI: +0.8 to +3.5) for severe AS patients.

Conclusions: Moderate AS appears to be associated with a mortality risk higher than no or mild AS but lower than severe AS, which increases in specific population subsets. The impact of early intervention in moderate AS patients having high-risk features deserves further investigation.

Keywords: death; heart failure; meta-analysis; moderate aortic stenosis.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Coisne is supported by grants from Fédération Française de Cardiologie, Institut Servier, Fondation Monahan, and Fulbright; and served as consultant for Abbott Vascular and received speaker fees from Abbott Vascular and GE Healthcare. Dr Montaigne is supported by grants from the National Center for Precision Diabetic Medicine (PreciDIAB) (ANR-18-IBHU-0001, 20001891/NP0025517, 2019_ESR_11). Dr Latib has served on advisory boards or as a consultant for Medtronic, Boston Scientific, Philips, Edwards Lifesciences, and Abbott. Dr Généreux has served as a consultant for Abbott Vascular, Abiomed, BioTrace Medical, Boston Scientific, CARANX Medical, Cardiovascular System Inc., Edwards Lifesciences, GE Healthcare, iRythm Technologies, Medtronic, Opsens, Pi-Cardia, Puzzle Medical, Saranas, Shockwave, Siemens, Soundbite Medical Inc, Teleflex, and 4C Medical; has served as an advisor for Abbott Vascular, Abiomed, BioTrace Medical, Edwards Lifesciences, and Medtronic; has received speaker fees from Abbott Vascular, Abiomed, BioTrace Medical, Edwards Lifesciences, Medtronic, and Shockwave; has served as the principal investigator in the ECLIPSE trial, EARLY-TAVR trial, PROGRESS trial; served as proctor for Edwards Lifesciences; has received institutional research grant support from Edwards Lifesciences; and owns equity in Pi-Cardia and Puzzle Medical, Saranas, and Soundbite Medical Inc. Dr Bax has served on the Speakers Bureau of Abbott and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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