Clinical Characteristics And Prognosis Of Elderly Patients With Calcified Aortic Stenosis

Abstract 1 Clinical Features of Calcific Aortic Valve Stenosis in Subjects Older than 75 years of Age[Objective] To analyze the risk factors for in-patients mortality who were older than 75 years of age with calcific aortic valve stenosis.[Methods] Clinical data of 421 consecutive patients older than 75 years who were diagnosed aortic stenosis by Ultrasonic echocardiography but not Rheumatic pathogenic between January 2008 and January 2015 in our institution were retrospectively analyzed. By Ultrasonic echocardiography, patients were divided into mild stenosis group moderate stenosis group and severe stenosis group. All patients were followed at 1 year. The primary end point was death from any cause and cardiac death. Univariate analysis was used to identify the potential risk factors and multivariate logistic regression was used to determine the independent risk factors.[Results] All patients with the mean age of 79.1±3.5(from 75 to 94) had 57.7% male. The total mortality and cardiac mortality of all patients were 22.3% and 19.7%. There were 112 patients in mild group and 83 patients in moderate group and 226 patients in severe group. Three variables including Peripheral vascular disease (OR=2.31,95% CI:1.215-4.392), EF(OR=0.966,95% CI:0.942-0.991),NT-proBNP grouping (OR=2.022,95% CI:1.14-3.586) were independently correlated with patient all cause mortality of one year. Four variables including diabetes (OR=2.157,95% CI: 1.213-3.836),EF (OR=0.975,95% CI:0.95-1), NT-proBNP grouping (OR=2.786, 95% CI:1.449-5.356), phosphorus of blood (OR=5.755,95% CI:1.462-22.657) were independently correlated with cardiac mortality of one year.[Conclusion] Among the patients older than 75 years of age, there was no difference of 1-year total and cardiac mortality between mild, moderate and severe stenosis groups. Peripheral vascular disease,EF,NT-proBNP grouping were independently risk factors of 1-year all cause mortality, and diabetes, EF, NT-proBNP, phosphorus of blood were independently predictive of 1-year cardiac mortality.Abstract 2 Effect of Left Ventricular Systolic Dysfunction on Mortality of older Patients with Moderate to Severe Aortic Stenosis[Objective]To evaluate the clinical outcome of patients older than 75 Years of age with Moderate to Severe Aortic Stenosis, so we can find a suitable boundary value of left ventricular systolic dysfunction.[Methods] Clinical data of 301 consecutive patients older than 75 years who were diagnosed moderate to severe aortic stenosis by Ultrasonic echocardiography but not Rheumatic pathogenic between January 2008 and January 2015 in our institution were retrospectively analyzed. All patients were followed to January 2016. The primary end point was death from any cause. According to the EF, patients were divided into normal subjects and low subjects, when the low EF was considered as below 5 level modifier 60%、55%、50%、45%、40%. From which, we found the appropriate EF cutoff points. Further, these two subjects (normal EF and low EF) were respectively divided into 3 groups:drug group, TAVR group and SAVR group. According to all cause mortality, we tried to found the differences among the study groups.[Results] There were 179 males(59.5%), with the mean age of 78.9±3.2, the mortality rate was 24.6%. The mortality was similar among the EF≤60% and EF>60%(27.2% vs 21.2%, p=0.2187), but was significantly difference among the EF≤ 55% and EF>55%(33.5% vs 20.1%, p=0.0055), EF≤50% and EF>50%(42.2% vs 19.7%, p<0.0001), EF≤45% and EF>45%(45.8% vs 20.2%, p<0.0001), EF≤40% and EF>40%(48.9%vs 21.1%, p<0.0001). Compared to EF>55% group, EF≤55% group was associated with a nearly twice increased likelihood of mortality[HR=0.568 (95% CI 0.34-0.947,p=0.03)]. When EF≤55%, the all cause mortality of drug treatment group was higher than EF>55% group(p=0.003). However, whether EF is normal or low by any boundary value, there was no difference in the total mortality when patients treated by TAVR and/or SAVR.[Conclusion] Among the patients older than 75 Years of age with Moderate to Severe Aortic Stenosis, the total mortality is obviously increased when EF≤55%. These patients with drug treatment have higher mortality than any other treatment subjects. In TAVR and/or SAVR group, EF is not associated with total mortality.Abstract 3 Clinical Features of Calcific severe aortic Valve stenosis in Older Patients:outcomes and comparison of operative risk scores[Objective] To analyze the risk factors for in-patients mortality who were older than 75 years of age with calcific severe aortic valve stenosis. We sought to analyze mortality and to compare the security of different treatment. We sought to analyze operative mortality and to compare the predictive accuracy of the logistic European System for Cardiac Operative Risk Evaluation score (EuroSCORE) Ⅰ, EuroSCORE Ⅱ and Society of Thoracic Surgeons (STS) score in this population.[Methods] We retrospectively enrolled 226 consecutive patients older than 75 years who were diagnosed aortic severe stenosis by Ultrasonic echocardiography but not Rheumatic pathogenic between January 2008 and January 2015 in our institution. All patients were followed at 1 year and calculated surgical risk scores. The primary end point was death from any cause and cardiac death. Compare the differences in mortality among groups of drug treatment, PBAV, TAVR and SAVR. Univariate analysis was used to identify the potential risk factors and multivariate logistic regression was used to determine the independent risk factors.[Results] The mortality of 99 patients treated by drug,9 patients treated by PBAV, 56 patients treated by TAVR,62 patients treated by SAVR were 46.1%、44.4%、7.2%、 6.5%. The mortality was similar between TAVR and SAVR (p=0.8963). but was significantly difference between drug and TAVR/SAVR (p<0.0001). Mean logistic EuroSCORE, EuroSCORE Ⅱ and STS score were 20.5±13.4、4.6±2.7 and 3.8±2.9 in TAVR group, and 14.1±11.0、3.7±2.5 and 3.3±1.4 in SAVR group. Logistic EuroSCORE showed overestimation of operative mortality, whereas EuroSCORE Ⅱ and STS showed good calibration. The area under the ROC curve of TAVR and SAVR were 0.843(95% CI 0.598-1.0) and 0.897(95% CI 0.800-0.993) for logistic EuroSCORE, 0.855(95% CI 0.668-1.0) and 0.897(95% CI 0.774-1.0) for EuroSCORE Ⅱ、0.899(95% CI 0.802-0.996) and 0.899(95% CI 0.687-1.0)for STS, p<0.05. Three variables including diabetes mellitus (OR=0.65,95% CI:1.056-3.471), left ventricular ejection fraction (OR=-0.036,95% CI:0.945-0.984), Concomitant mitral/tricuspid valve disease (OR=0.742,95% CI:1.104-3.991) were independently correlated with patient all cause mortality of one year.[Conclusion] These results suggest that AVR can be performed safely in selected older patients. The mortality of drug treatment was higher, and equivalent curative effect between TAVR and SAVR. Diabetes mellitus, left ventricular ejection fraction, Concomitant mitral/tricuspid valve disease were independently risk factors of 1-year all cause mortality. EuroSCORE II and STS demonstrated superior calibration and should be the preferred tools for risk assessment, at least for this population.