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07. Syncope and Bradycardia
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32. Cardiovascular Nursing
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Prognostic implications of aortic stenosis progression rate
Session:
Posters (Sessão 2 - Écran 4) - Doença valvular
Speaker:
Rafael Silva Teixeira
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.7 Valvular Heart Disease - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Rafael Silva Teixeira; André Lobo; Marta Catarina Almeida; Diana Ribeiro; Fábio Sousa Nunes; Marta Leite; Diogo Santos; Mariana Brandão; Mariana Silva; Gualter Silva; Silvia Diaz; António Barros; Francisca Saraiva; Francisco Sampaio; Ricardo Fontes-Carvalho
Abstract
<p><strong>Introduction</strong>: Aortic stenosis (AoS) is a progressive disease of the aortic valve (AoV) and ultimately of the myocardium, potentially fatal. Most studies assume that the rate of AoS progression is time-invariant while recognizing wide variability between patients (pts) and among the same patient.</p> <p><strong>Aim</strong>: 1) evaluate the rate of AoS progression, 2) cluster pts into rapid progressors (RP) and slow progressors (SP) and explore possible predictors, and 3) evaluate the impact of progression rate on cardiac damage and survival.</p> <p><strong>Methods:</strong> We retrospectively identified 914 pts (age 76 ± 8 years, 52% female, median follow-up time 6.8 years) with mild to severe AoS who had undergone > 1 echocardiogram from 2012 to 2020. Seriated echocardiograms, biomarkers, and clinical records were consulted, providing a multiparametric data frame for modeling AoS progression and consequences. Bayesian hierarchical models were trained using machine learning algorithms (MLA) to predict aortic peak velocity (AoPV) as a function of time. After selecting the best model, individual AoS acceleration rates were estimated from the posterior distribution, and pts were clustered in RP and SP using MLA. </p> <p><strong>Results</strong>: AoPV was best modeled by a logistic function of time. 483 pts were clustered as RP (53%) and 431 as SP (47%) with acceleration rates estimated at 0.14 ± 0.02 years-1 and 0.09 ± 0.02 years-1, respectively (p< 0.01). No association between progression rate and clinical variables was found. At 8 years, RP had a higher incidence of cardiac damage than SP (p=0.01). Rapid progression was associated with higher mortality (Hazard Ratio (HR) 1.28, p=0.02), persisting after adjustment for demographics, comorbidities, AoS severity, and time-dependent AoV replacement (HR 1.36, p<0.01). A 5-year mortality prediction model incorporating AoS progression rate to age, gender and AoS severity displayed higher performance (AUROC 0.82, p<0.01, Brier score 0.11, net clinical benefit of 2% assuming a threshold predicted probability of death of 50%) than a model without the progression rate.</p> <p><strong>Conclusions</strong>: A nonlinear model of AoS progression and two clusters of progressors were identified. Rapid progression was associated with earlier cardiac damage and higher mortality, independent of baseline AoS severity. Incorporating AS acceleration rate in clinical practice can improve AoS stratification and provide a proactive time frame for follow-up and intervention.</p>
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