Asma Brahim

Faculty of medicine, Tunisia

Title: Determinants Of Mid-Term Prognosis Of Severe Aortic Stenosis: Conclusions From Valve-National Tunisian Registry

Biography

She has a deep passion for medicine and science. She has chosen the specialty of her dreams and has presented her work at some of the most prestigious cardiology congresses: in 2022, in Dubai, at the joint congress of the American Society of Cardiology and the Emirati Society of Cardiology; and in 2023, in Amsterdam, with the European Society of Cardiology.

Abstract

Introduction: Severe aortic stenosis (SAS) is the most common acquired heart valve disease in adults with a poor prognosis. Over several decades, the only curative treatment was cardiac surgery for aortic valve replacement, a procedure that was too cumbersome to treat a large number of elderly, comorbid and frail patients, who consequently found themselves at a therapeutic impasse. 

Our aim of this study was to determine the prognostic factors of SAS and the impact of valve interventions when realized.

Methodology: This study is based on the results of the first Tunisian national observational register of valvular diseases: NATURE-VALV, which was a cross-sectional, prospective, multicenter, descriptive and analytical study in all cardiology departments in Tunisia in the private and public sectors from September 2020 to December 2021. 

Results: In total we included 400 patients. The mean age in our study was 66.4 years. Forty-nine patients (12.3%) underwent intervention. The most frequent cause of SAS was degenerative, followed by rheumatic in our study population. The left ventricle (LV) strain was significantly higher in the operated group (15% vs 13.3 p=0.038). The rate of complications at twelve months was similar between the two groups, operated and non-operated, with a rate of 16% in each group. In fact, there was no difference in terms of mortality between the two groups (13% vs 10%). Furthermore, in our study, we found that age, valve replacement with a mechanical prosthesis, LV systolic dysfunction, dilatation and LV systolic dysfunction were identified as factors contributing to mortality in patients with SAS. Obesity, chronic heart failure, coronary artery disease (CAD) and left bundle branch block were identified as predictors of mortality, but with rather weak associations. Predictors of hospitalization for cardiac decompensation were CAD and LV and right ventricular systolic dysfunction. Dyspnea already present at inclusion, obesity and pulmonary artery hypertension (PAH) were also predictive of decompensation, but with low strength of association.

Conclusion: Despite the intrinsic limitations of this first national NATURE Valve registry, the low intervention rate, and certain shortcomings in patient follow-up, this registry enabled us to conclude that LV and RV systolic dysfunction, associated with PAH, mitral valve disease or CAD, further worsens the prognosis.