Moderate Aortic Stenosis - Patients survival and the factors that impact it: Analysis using propensity score models.

Patients suffering from Moderate Aortic Stenosis (AS) show conflicting survival data in recent publications. The purpose of the current analysis was to assess survival and evaluate the influencers on survival of patients with Moderate AS. Methods: SHARE (Sheba HeArt RegistEry) is an historical retrospective cohort of all patients evaluated at Leviev Heart Center between 2007 and 2019. The current analysis included all patients who underwent echocardiographic evaluation. Aortic stenosis severity was extracted for all patients from the echocardiographic reports. All-cause mortality and was available for all patients. Subjects with severe AS or history of aortic valve replacement were excluded from the analysis. Results: Cohort included 98,216 subjects of whom 54,364 (55%) were outpatients. Final cohort included 92,622 patients with a median age of 63 (IQR 51-74) and 58% were men. There were 2,202 (2%) with Moderate AS. During a median follow up of 5.3 [IQR 2.6-8.4] years 19,712 (21%) patients died. Kaplan-Meier survival analysis demonstrated 278% increase in mortality of moderate AS patients (95% CI 2.59-2.98, P < 0.001). Propensity matching of 52% of patients for whom clinical laboratory and medication data was available showed that patients with Moderate AS (N=1,448) were 17% more likely to die (95% CI 1.04-1.30, p = .007). Interaction analysis demonstrated that the association of moderate AS with survival was dependent on left ventricular ejection fraction and in octogenarians (P for interaction 0.001 and 0.016 respectively, Figure 1), Two more propensity models were constructed using a more liberal (Including mild-moderate) and a more restrictive (including only patients with Mean Aortic Valve Velocity > 20) definition of Moderate AS and results were consistent throughout. Conclusion: Moderate AS is associated with worse survival and survival is modified by age and LVEF.