SPC365

High-Risk Features in Severe Aortic Stenosis: A Prospective Assessment Before Aortic Valve Replacement

Session: Sessão de Posters 39 - Fenótipos de estenose aórtica, imagem e fisiopatologia
Speaker: Luís Cotrim

Congress: CPC 2026
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 15. Valvular Heart Disease
Subtheme: 15.2 Valvular Heart Disease – Epidemiology, Prognosis, Outcome
Session Type: Posters Eletrónicos
FP Number: ---
Authors: Luís Cotrim; Rodrigo Brandão; Tiago Mesquita; Inês Miranda; Filipa Gerardo; Inês Santos; Mariana Passos; Inês Fialho; David Roque; Carlos Morais

<p style="text-align:justify"><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Background:</span></span></strong></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Severe aortic stenosis (AS) frequently progresses to clinical instability when definitive valve intervention is postponed. Despite aortic valve replacement (AVR) being the recommended therapy, procedural waiting times remain long, and a meaningful proportion of patients experience major adverse cardiovascular events (MACE) before reaching intervention. Improved delineation of vulnerable phenotypes may enhance prioritization and surveillance during this pre-interventional period.</span></span></p>

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<p style="text-align:justify"><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Objective:</span></span></strong></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">To characterize the clinical and echocardiographic determinants of MACE in individuals with severe AS awaiting AVR.</span></span></p>

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<p style="text-align:justify"><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Methods:</span></span></strong></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">A prospective cohort was assembled including consecutive patients with severe AS assessed by a single-center Heart Team between January 2019 and June 2022. Detailed clinical history, laboratory profiles, and advanced echocardiographic measurements were obtained at baseline. MACE was defined as a composite of all-cause mortality, heart failure (HF) hospitalization, non-fatal myocardial infarction and non-fatal stroke. Outcomes were tracked until AVR. Median follow-up duration was 187 days (IQR 59&ndash;352).</span></span></p>

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<p style="text-align:justify"><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Results:</span></span></strong></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">The study enrolled 255 patients (mean age 76.7 &plusmn; 10.7 years; 48.1% male). Several factors demonstrated independent prognostic relevance. A prior hospitalization for HF was strongly associated with subsequent MACE (HR 2.77; 95% CI 1.66&ndash;4.62; p &lt; 0.001). Advanced symptom burden, reflected by NYHA class &ge; III, also conferred increased risk (HR 2.64; 95% CI 1.58&ndash;4.39; p &lt; 0.01). Left ventricular systolic dysfunction emerged as a major determinant of adverse events (HR 2.86; 95% CI 1.71&ndash;4.78; p &lt; 0.001). Pulmonary hypertension provided additional prognostic information (HR 2.16; 95% CI 1.27&ndash;3.66; p &lt; 0.01). In contrast, right ventricular dysfunction was not predictive (HR 2.34; 95% CI 0.45&ndash;12.08; p = 0.31). Valvular regurgitation significantly contributed to risk stratification: moderate&ndash;severe tricuspid regurgitation (HR 10.88; 95% CI 1.41&ndash;83.94; p &lt; 0.05) and moderate&ndash;severe mitral regurgitation (HR 5.91; 95% CI 1.50&ndash;23.34; p &lt; 0.05) identified a distinctly high-risk subgroup. Laboratory indices, including creatinine, haemoglobin and NT-proBNP, did not exhibit meaningful associations with MACE.</span></span></p>

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<p style="text-align:justify"><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">Conclusions:</span></span></strong></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif">In patients with severe AS awaiting AVR, markers of clinical decompensation and impaired cardiac hemodynamics, namely prior HF hospitalization, significant symptomatic limitation, left ventricular systolic dysfunction and pulmonary hypertension, were key predictors of adverse events. Concomitant moderate&ndash;severe tricuspid or mitral regurgitation further delineated individuals at high risk. These results emphasize the need for more structured risk-based pathways to optimize care for patients during the pre-interventional period.</span></span></p>