title: Prevalence and prognostic impact of comorbidities in patients with severe aortic valve stenosis.
abstract: In patients with severe aortic valve stenosis (valve area <or= 1 cm(2), AS), the prevalence and the prognostic impact of comorbidities is unknown. Fifty-eight patients with severe AS (mean aortic valve area 0.8 +/- 0.2 cm(2)), who underwent cardiac catheterization and 2-D/Doppler echocardiography, were prospectively enrolled. The glomerular filtration rate (eGFR) was estimated using the abbreviated Modification of Diet in Renal Disease Study equation. Death from a cardiac cause was defined as study end point. Coronary artery disease was present in 33 patients (57%). Subsequently, 43 patients (77%) underwent aortic valve replacement. During a follow-up of 485 +/- 336 days, 11 patients suffered a cardiac death. Survivors and non-survivors did not differ with respect the prevalence of coronary artery disease, invasive hemodynamic measurements or echocardiographic variables of systolic/diastolic function. Non-survivors were in a poorer NYHA functional class (3.2 +/- 0.3 vs 2.4+/-0.8, p = 0.002), had a lower eGFR (33.4 +/- 15.5 ml/min/1.73 m(2) vs 49.1 +/- 15.6 ml/min/1.73m(2), p = 0.004), a higher prevalence of diabetes mellitus (73% vs. 22%, p = 0.0001) and a lower serum hemoglobin level (11.6 +/- 2.1 vs 13.0 +/- 1.5 g/dL, p = 0.017). By multivariate Cox analysis, NYHA class (hazard ratio: 6.17, p = 0.013) and eGFR (hazard ratio 0.95, p = 0.04) were independent prognostic predictors. In patients with eGFR < 41.8 ml/min/1.73 m(2) (cut-off value derived from ROC analysis, area under the curve: 0.78 +/- 0.08), outcome was markedly poorer as compared to patients with eGFR > 41.8 ml/min/1.73 m(2) (event-free survival rate of 38% vs 93%, p = 0.004). Thus, in patients with severe AS, comorbidities are frequent, and particularly kidney disease significantly impacts longterm outcome.
authors.affiliation: Universitätsklinikum Münster, Medizinische Klinik und Poliklinik C (Kardiologie und Angiologie), Albert-Schweitzer-Str. 33, 48129 Münster, Germany. bruch@uni-muenster.de
authors.forename: Christian
authors.initials: C
authors.lastname: Bruch
authors.forename: Daniela
authors.initials: D
authors.lastname: Kauling
authors.forename: Holger
authors.initials: H
authors.lastname: Reinecke
authors.forename: Markus
authors.initials: M
authors.lastname: Rothenburger
authors.forename: Hans Heinrich
authors.initials: HH
authors.lastname: Scheld
authors.forename: Günter
authors.initials: G
authors.lastname: Breithardt
authors.forename: Thomas
authors.initials: T
authors.lastname: Wichter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D006328:Cardiac Catheterization; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology*; D008297:Male; D015995:Prevalence; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index