TY - JOUR
T1 - Relationship Between Anemia and Sudden Cardiac Death in Patients With Severe Aortic Stenosis
AU - Ducharme-Smith, Allison
AU - Chahal, C. Anwar A.
AU - Sawatari, Hiroyiku
AU - Podboy, Alex
AU - Sherif, Akil
AU - Scott, Christopher G.
AU - Brady, Peter A.
AU - Gersh, Bernard J.
AU - Somers, Virend K.
AU - Nkomo, Vuyisile T.
AU - Pellikka, Patricia A.
N1 - Funding Information:
Supported by the Mayo Clinic Center for Clinical and Translational Science and the Mayo Clinic Departments of Internal Medicine and Cardiology . This publication was made possible by support from the Research Division of the Department of CV Medicine and the Clinical and Translational Science Award Grant Number UL1 TR000135, supporting the Mayo Clinic Center for Clinical and Translational Science (CCaTS), from the National Center for Advancing Translational Sciences (NCATS), a component of NIH (The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the NIH). CAAC and VKS are supported by NIH HL65176 and NIH HL134885. CAAC is supported by the American Heart Association (Award number 17POST33400211).
Funding Information:
Supported by the Research Division of the Department of CV Medicine and the Clinical and Translational Science Award grant number UL1 TR000135 , supporting the Mayo Clinic Center for Clinical and Translational Science (CCaTS), from the National Center for Advancing Translational Sciences (NCATS) , a component of NIH , Bethesda, Maryland, (The contents of this article are solely the responsibility of the authors and do not necessarily represent the official view of the NIH). CAAC and VKS are supported by NIH HL65176 and NIH HL134885 . CAAC is supported by the American Heart Association , Dallas, Texas, grant number 17POST33400211 ).
Publisher Copyright:
© 2020
PY - 2020/12/1
Y1 - 2020/12/1
N2 - Aortic stenosis (AS) is associated with significant morbidity and mortality, including sudden cardiac death (SCD). Anemia is a known risk factor for mortality in patients with AS. We sought to understand the prognostic implications between anemia and SCD in severe AS. The Mayo Clinic AS database includes 8,357 adults with severe AS (mean gradient ≥40 mm Hg, aortic valve area ≤1 cm2, or peak aortic jet velocity ≥4 m/s) enrolled between January 1, 1995 and April 30, 2015. Survival and cause of death were ascertained from the National Death Index and SCD from medical records. We excluded patients with multiple valvular abnormalities, leaving 7,292 subjects. The median (interquartile range, [IQR]) age was 76 (68, 82) years with 56% male, and median (IQR) hemoglobin level was 12.9 (11.6, 14.1) g/dl. The frequency of anemia (hemoglobin <13.0g/dl for men, <12.0 g/dL for women) was 40%. During median (IQR) follow up of 4.4 (1.8, 8.1) years, 4,056 died (10-year survival 38%) including 225 with SCD (10-year cumulative incidence 5%). In a multivariate model including age, sex, body-mass index, hypertension, diabetes mellitus, myocardial infarction, estimated glomerular filtration rate, and time dependent aortic valve replacement, anemia was associated with increased all-cause mortality (hazard ratios 1.75, 95%CI 1.64, 1.87; p < 0.001) and increased SCD mortality (hazard ratios 1.42, 95%CI 1.07, 1.86; p = 0.01). In conclusions, anemia is a frequent finding in patients with severe AS and independently associated with increased all-cause mortality and SCD. Anemia may be a useful prognostic marker and a modifiable therapeutic target in managing patients with severe AS
AB - Aortic stenosis (AS) is associated with significant morbidity and mortality, including sudden cardiac death (SCD). Anemia is a known risk factor for mortality in patients with AS. We sought to understand the prognostic implications between anemia and SCD in severe AS. The Mayo Clinic AS database includes 8,357 adults with severe AS (mean gradient ≥40 mm Hg, aortic valve area ≤1 cm2, or peak aortic jet velocity ≥4 m/s) enrolled between January 1, 1995 and April 30, 2015. Survival and cause of death were ascertained from the National Death Index and SCD from medical records. We excluded patients with multiple valvular abnormalities, leaving 7,292 subjects. The median (interquartile range, [IQR]) age was 76 (68, 82) years with 56% male, and median (IQR) hemoglobin level was 12.9 (11.6, 14.1) g/dl. The frequency of anemia (hemoglobin <13.0g/dl for men, <12.0 g/dL for women) was 40%. During median (IQR) follow up of 4.4 (1.8, 8.1) years, 4,056 died (10-year survival 38%) including 225 with SCD (10-year cumulative incidence 5%). In a multivariate model including age, sex, body-mass index, hypertension, diabetes mellitus, myocardial infarction, estimated glomerular filtration rate, and time dependent aortic valve replacement, anemia was associated with increased all-cause mortality (hazard ratios 1.75, 95%CI 1.64, 1.87; p < 0.001) and increased SCD mortality (hazard ratios 1.42, 95%CI 1.07, 1.86; p = 0.01). In conclusions, anemia is a frequent finding in patients with severe AS and independently associated with increased all-cause mortality and SCD. Anemia may be a useful prognostic marker and a modifiable therapeutic target in managing patients with severe AS
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U2 - 10.1016/j.amjcard.2020.09.007
DO - 10.1016/j.amjcard.2020.09.007
M3 - Article
C2 - 32946861
AN - SCOPUS:85092048279
SN - 0002-9149
VL - 136
SP - 107
EP - 114
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -