Stable, Progressive, and Acute Valve Syndrome in Severe Aortic Stenosis: Insights from the CURRENT AS Registry‐2.

BACKGROUND: A valve syndrome framework (stable valve syndrome [SVS], progressive valve syndrome [PVS], and acute valve syndrome [AVS]) integrates clinical presentation with objective markers, but its prognostic implications remain incompletely characterized. METHODS: Among 3369 consecutive patients with severe aortic stenosis (AS) in the CURRENT AS Registry-2, we analyzed 2824 patients with natriuretic peptide (NP) and left ventricular ejection fraction (LVEF) data. Patients were classified as SVS (no symptoms with low NP), PVS (mild symptoms and/or mildly elevated NP), or AVS (acute deterioration and/or markedly elevated NP or reduced LVEF), and stratified by initial aortic valve replacement (AVR) and conservative strategies. The primary outcome was a composite of death or heart failure hospitalization. Subgroup analyses further classified patients into five phenotypes: SVS, progressive valve signs without symptoms, progressive valve symptoms, acute valve signs without symptoms, and acute valve symptoms. RESULTS: In the initial AVR stratum, AVS was associated with higher risk for the primary outcome compared with SVS (adjusted HR 2.34, 95% CI 1.19-4.59, P=0.01), whereas PVS was not. In the conservative stratum, SVS demonstrated a very low early event rate (1.0% at 6 months), while AVS and PVS had higher risk than SVS. In the five-phenotype analysis, patients with progressive valve signs without symptoms underwent AVR at rates comparable to SVS yet had worse outcomes than SVS in the conservative stratum (adjusted HR 1.89, 95% CI 1.18-3.03, P=0.008). CONCLUSIONS: A valve syndrome framework highlights limitations of symptom-based risk stratification and may refine surveillance and intervention strategies in severe AS.

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Journal
Journal of the American Heart Association
Published
2026-06-25
DOI
https://doi.org/10.1161/jaha.126.050490
Primary Topic
Cardiac Valve Diseases and Treatments
Type
article
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article

Stable, Progressive, and Acute Valve Syndrome in Severe Aortic Stenosis: Insights from the CURRENT AS Registry‐2.

Norio Kanamori, Mitsuru Ishii, Koh Ono, Kotaro Takahashi et al.
Journal of the American Heart Association
Cardiac Valve Diseases and Treatments
article

Stable, Progressive, and Acute Valve Syndrome in Severe Aortic Stenosis: Insights from the CURRENT AS Registry‐2.

Norio Kanamori, Mitsuru Ishii, Koh Ono, Kotaro Takahashi, Tomohiko Taniguchi, Ryosuke Murai, Yuki Obayashi, Yasutaka Inuzuka, Yasuaki Takeji, Shunsuke Usami, Makoto Miyake, Ryusuke Nishikawa, Fumiko Nakazeki, Kohei Osakada, Satoshi Shizuta, Mitsuru Abe, Manabu Shirotani, Hiroyuki Tabata, Masahiro Kimura, Kenji Minatoya, Yutaka Furukawa, Kenji Andò, Yusuke Yoshikawa, Hiroki Shiomi, Ko Yamamoto, Kazuya Nagao, Kenji Nakatsuma, Masayasu Izuhara, Takeshi Morimoto, Chisato Izumi, Eisaku Nakane, Masashi Amano, Takeshi Kitai, Takeshi Kimura, Koichiro Murata, Shinichi Shirai, Hiroyuki Nakayama, Tomohisa Tada, the CURRENT AS Registry-2 Investigators
article en

Abstract

BACKGROUND: A valve syndrome framework (stable valve syndrome [SVS], progressive valve syndrome [PVS], and acute valve syndrome [AVS]) integrates clinical presentation with objective markers, but its prognostic implications remain incompletely characterized. METHODS: Among 3369 consecutive patients with severe aortic stenosis (AS) in the CURRENT AS Registry-2, we analyzed 2824 patients with natriuretic peptide (NP) and left ventricular ejection fraction (LVEF) data. Patients were classified as SVS (no symptoms with low NP), PVS (mild symptoms and/or mildly elevated NP), or AVS (acute deterioration and/or markedly elevated NP or reduced LVEF), and stratified by initial aortic valve replacement (AVR) and conservative strategies. The primary outcome was a composite of death or heart failure hospitalization. Subgroup analyses further classified patients into five phenotypes: SVS, progressive valve signs without symptoms, progressive valve symptoms, acute valve signs without symptoms, and acute valve symptoms. RESULTS: In the initial AVR stratum, AVS was associated with higher risk for the primary outcome compared with SVS (adjusted HR 2.34, 95% CI 1.19-4.59, P=0.01), whereas PVS was not. In the conservative stratum, SVS demonstrated a very low early event rate (1.0% at 6 months), while AVS and PVS had higher risk than SVS. In the five-phenotype analysis, patients with progressive valve signs without symptoms underwent AVR at rates comparable to SVS yet had worse outcomes than SVS in the conservative stratum (adjusted HR 1.89, 95% CI 1.18-3.03, P=0.008). CONCLUSIONS: A valve syndrome framework highlights limitations of symptom-based risk stratification and may refine surveillance and intervention strategies in severe AS.

Journal of the American Heart Association
Kanazawa University (JP), Tenri Hospital (JP), Kyoto Medical Center (JP), Kurashiki Central Hospital (JP), Kishiwada City Hospital (JP), National Cerebral and Cardiovascular Center (JP), Nara Medical University Hospital (JP), Kansai Electric Power Hospital (JP), Shimada Municipal Hospital (JP), Shizuoka City Hospital (JP), Otsu Red Cross Hospital (JP), Shizuoka General Hospital (JP), Hyogo Prefectural Amagasaki General Medical Center (JP), Mitsubishi Kyoto Hospital (JP), Kyoto University Hospital (JP), Osaka Red Cross Hospital (JP), Japanese Red Cross Society Wakayama Medical Center (JP), Shiga Medical Center (JP), Kitano Hospital (JP), Kokura Memorial Hospital (JP), Kobe City Medical Center General Hospital (JP), Municipal Hirakata City Hospital (JP), Hyogo University (JP), Kindai University (JP)
Good health and well-being
Openalex Percentile: Top 7%
Cardiac Valve Diseases and Treatments
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