title: Advanced symptoms are associated with myocardial damage in patients with severe aortic stenosis.
abstract: Once aortic stenosis (AS) is severe, patients develop symptoms at different stages. Indeed, symptom status may correlate poorly with the grade of valve narrowing. Multiple pathophysiological mechanisms, other than valvular load, may explain the link between AS and symptom severity. We aimed to describe the relationship between the severity of symptoms and the characteristics of a cohort of patients with severe AS already referred for aortic valve replacement (AVR).
  
  
  
  We analyzed 118 consecutive patients (70±9 years, 55% men) with severe AS referred for AVR. We identified 84 patients with New York Heart Association (NYHA) I-II, and 34 with NYHA III-IV symptoms. Clinical and echocardiographic parameters were compared between these two groups. Left ventricular ejection fraction (LVEF), global longitudinal peak systolic strain (GLPS), NT-pro-B-type natriuretic peptide (BNP), and high-sensitive troponin T (hs-TNT) were determined at the time of admission.
  
  
  
  AS severity was similar between groups. Compared with the NYHA I-II group, patients in NYHA III-IV group were older and more likely to have comorbidities, worse intracardiac hemodynamics and more LV damage. Variables independently associated with NYHA III-IV symptomatology were the absence of sinus rhythm, higher E/e' ratio, and increased hs-TNT. GLPS showed a good correlation not only with hs-TNT as a marker of myocardial damage, but also with markers of increased afterload imposed on LV, being not directly related with advanced symptoms.
  
  
  
  Advanced symptoms in patients with severe AS referred for AVR are associated with worse intracardiac hemodynamics, absence of sinus rhythm, and more myocardial damage. It supports the concept of transition from adaptive LV remodeling to myocyte death as an important determinant of symptoms of heart failure.
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany. Electronic address: spampinatoricardo@gmail.com.
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Spampinato
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Manuela
authors.initials: M
authors.lastname: Tasca
authors.affiliation: Division of Cardiac, Thoracic and Vascular Surgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Valerie
authors.initials: V
authors.lastname: Schloma
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Yaroslava
authors.initials: Y
authors.lastname: Dmitrieva
authors.affiliation: Center for Clinical Trials (KKS), University of Leipzig, Leipzig, Germany.
authors.forename: Meinhard
authors.initials: M
authors.lastname: Mende
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Thilo
authors.initials: T
authors.lastname: Noack
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Elfriede
authors.initials: E
authors.lastname: Strotdrees
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Friedrich-W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000097:blood / Q000503:physiopathology* / Q000601:surgery; D015415:Biomarkers; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology*; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D012720:Severity of Illness Index; D063189:Symptom Assessment; D020107:Troponin T / Q000097:blood; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Aortic valve stenosis; Biomarkers; Functional class; Global longitudinal strain; High-sensitive troponin T