title: Prognostic implications in patients with symptomatic aortic stenosis and preserved ejection fraction: Japanese multicenter aortic stenosis, retrospective (JUST-R) registry.
abstract: Current prognostic implication of symptomatic patients with aortic stenosis (AS) remains undetermined. This study investigated the current prognostic implications of AS-related symptoms and the effect of aortic valve replacement (AVR) on outcome.
  
  
  
  We enrolled 586 consecutive patients with severe AS (aortic valve area <1.0cm2) with preserved left ventricular ejection fraction (≥50%). All patients were stratified into the following four groups based on the predominant symptoms: Group 1, asymptomatic (n=316); Group 2, chest pain (n=41); Group 3, heart failure (n=192); or Group 4, syncope (n=37).
  
  
  
  AS-related symptoms were diagnosed in 270 patients (46.1%), among whom 182 patients (32.2%) received AVR. Thirty-nine patients (6.7%) had cardiac death during the mean follow-up of 16±14 months. AVR was associated with significant reduction in cardiac death in Groups 3 (p<0.001) and 4 (p=0.004) whereas no significant prognostic advantage of AVR was observed in Groups 1 or 2. Cox proportional-hazard multivariate analysis revealed that age, heart failure, and mean pressure gradient (PG) were associated with increased risk of cardiac death in all patients regardless of AVR [hazard ratio (HR): 1.079, 2.090, and 1.008 respectively, all p<0.05]. In the patients without AVR, age, heart failure, syncope, and mean PG were independently associated with cardiac death (HR: 1.130, 3.639, 4.638, and 1.008, all p<0.05).
  
  
  
  This retrospective study demonstrated the current associations between the types of AS symptoms and prognosis in Japanese patients with severe AS.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan. Electronic address: heartizumo@yahoo.co.jp.
authors.forename: Masaki
authors.initials: M
authors.lastname: Izumo
authors.affiliation: Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takeuchi
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Seo
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Yamashita
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Kengo
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Ishizu
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Kimi
authors.initials: K
authors.lastname: Sato
authors.affiliation: Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Oshima
authors.affiliation: Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma
authors.affiliation: Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Otsuji
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Yoshihiro J
authors.initials: YJ
authors.lastname: Akashi
mesh_terms: D000367:Age Factors; D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D001794:Blood Pressure; D002637:Chest Pain / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000401:mortality; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D013318:Stroke Volume; D013575:Syncope
keywords: Aortic valve stenosis; Echocardiography; Prognosis