Author + information
- Received March 5, 2018
- Revision received April 19, 2018
- Accepted April 19, 2018
- Published online August 6, 2018.
- Eoin Donnellan, MDa,
- Brian P. Griffin, MDa,
- Douglas R. Johnston, MDb,
- Zoran B. Popovic, MD, PhDa,
- Alaa Alashi, MDa,
- Samir R. Kapadia, MDa,
- E. Murat Tuzcu, MDa,
- Amar Krishnaswamy, MDa,
- Stephanie Mick, MDb,
- Lars G. Svensson, MDb and
- Milind Y. Desai, MDa,∗ ()
- aDepartment of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- bDepartment of Cardiac Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Milind Y. Desai, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, Ohio 44195.
Objectives The aim of this study was to study differences in progression of aortic stenosis (AS) in patients with mediastinal radiotherapy (XRT)-associated moderate AS versus a matched cohort during the same time frame, and to ascertain need for aortic valve replacement (AVR) and longer-term survival.
Background Rate of progression of XRT-associated moderate AS and its impact on outcomes is not well-described.
Methods We included 81 patients (age 61 ± 13 years; 57% female) with at least XRT-associated moderate AS (aortic valve area [AVA] 1.05 ± 0.3 cm2; mean gradient 24 ± 10 mm Hg) who had ≥2 transthoracic echocardiograms (TTEs) 1 year apart and matched them in a 1:2 fashion on the basis of age, sex, and AVA with those without prior XRT. Serial aortic valve gradients and AVA were recorded. AVR and longer-term all-cause mortality during follow-up were recorded.
Results A total of 100% of patients had 1, a total of 71% had 2, and 39% had 3 follow-up TTEs. Before AVR, mean AVG and AVA were not significantly different between XRT and comparison groups. At 3.6 ± 2.0 years from baseline TTE, 146 (60%) underwent AVR (16% transcatheter), with significantly more patients in the XRT group undergoing AVR (80% vs. 50%; p < 0.01), at a much shorter time (2.9 ± 1.6 years vs. 4.1 ± 2.4 years; p < 0.01). At 6.6 ± 4.0 years from the initial TTE, 49 (20%) patients died, with a significantly higher mortality in the XRT group (40% vs. 11%; p < 0.01), with prior XRT associated with increased longer-term mortality, whereas AVR was associated with improved longer-term survival.
Conclusions In patients with moderate AS, those with prior XRT have a similar rate of progression of AS versus a comparison group. A higher proportion of patients in the XRT group were referred for AVR at a shorter time from baseline TTE. Despite that, the XRT patients had significantly higher longer-term mortality, and prior exposure to XRT was associated with significantly increased longer-term mortality.
Dr. Johnston is a consultant for Edwards LifeSciences, St. Jude Medical, KEF Holdings Inc., and iVHR. Dr. Desai is supported by the Haslam Family Endowed Chair in Cardiovascular Medicine. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 5, 2018.
- Revision received April 19, 2018.
- Accepted April 19, 2018.
- 2018 American College of Cardiology Foundation
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