<div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="602459755" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{10}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">A valve syndrome framework</span><span class="NormalTextRun SCXW13732284 BCX0">,</span><span> </span><span class="NormalTextRun SCXW13732284 BCX0">including both clinical presentation and objective markers</span><span class="NormalTextRun SCXW13732284 BCX0">,</span><span> </span><span class="NormalTextRun SCXW13732284 BCX0">could refine<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">surveillance and intervention strategies for<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">patients with<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">severe aortic stenosis<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">(AS)<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">who are asymptomatic</span><span class="NormalTextRun SCXW13732284 BCX0">,<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">according to<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">a<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">new</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>Japanese</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>registry</span><span class="NormalTextRun SCXW13732284 BCX0">.</span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="2063137174" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{12}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">The findings from the</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>CURRENT AS Registry-2</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>study were<span> </span></span></span><a class="Hyperlink SCXW13732284 BCX0" href="https://www.ahajournals.org/doi/10.1161/JAHA.126.050490" target="_blank" rel="noreferrer noopener"><span class="NormalTextRun SCXW13732284 BCX0" data-ccp-charstyle="Hyperlink">published online</span></a><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>in the<span> </span></span><em><span class="NormalTextRun SCXW13732284 BCX0">Journal of the American Heart Association</span></em><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">,<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">led by Tomohiko Taniguchi,<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">MD,<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">from Kobe City Medical<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW13732284 BCX0">Center</span><span class="NormalTextRun SCXW13732284 BCX0">, Japan.</span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="332348445" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{14}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">Traditionally,</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>the default</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>management strategies for asymptomatic patients with severe AS<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">have been based solely clinical surveillance at 6 and 12 months</span><span class="NormalTextRun SCXW13732284 BCX0">. </span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="1293503986" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{16}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">However, recent randomized controlled trials<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">and</span><span> </span></span><a class="Hyperlink SCXW13732284 BCX0" href="https://www.nejm.org/doi/full/10.1056/NEJMoa1912846" target="_blank" rel="noreferrer noopener"><span class="NormalTextRun SCXW13732284 BCX0" data-ccp-charstyle="Hyperlink">analyses</span></a><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span> </span><span class="NormalTextRun SCXW13732284 BCX0">have compared</span><span> </span><span class="NormalTextRun SCXW13732284 BCX0">early aortic valve replacement (AVR)<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">versus clinical surveillance</span><span class="NormalTextRun SCXW13732284 BCX0">,<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">demonstrat</span><span class="NormalTextRun SCXW13732284 BCX0">ing</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>tha</span><span class="NormalTextRun SCXW13732284 BCX0">t the latter<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">reduces unplanned cardiovascular or heart failure hospitalization and strokes.</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>These findings le</span><span class="NormalTextRun SCXW13732284 BCX0">d</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>to updated European<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">Society of Cardiology (ESC)<span> </span></span></span><a class="Hyperlink SCXW13732284 BCX0" href="https://academic.oup.com/eurheartj/article/46/44/4635/8234488" target="_blank" rel="noreferrer noopener"><span class="NormalTextRun SCXW13732284 BCX0" data-ccp-charstyle="Hyperlink">guidelines</span></a><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span> </span><span class="NormalTextRun SCXW13732284 BCX0">for early intervention to be considered a Class IIa alternative to<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">clinical surveillance in severe<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">but low surgical risk<span> </span></span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW13732284 BCX0">high-gradient</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>AS patients without symptoms. </span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="1011255692" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{18}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">“</span><span class="NormalTextRun SCXW13732284 BCX0">Nevertheless, it remains unclear which patients could be safely managed with watchful waiting without excess risk</span><span class="NormalTextRun SCXW13732284 BCX0">,” the researchers<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">wrote</span><span class="NormalTextRun SCXW13732284 BCX0">.</span><span> </span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" lang="EN-US" paraid="2112304005" paraeid="{7d43f7fa-06bf-456e-a3fd-5f60b5f92843}{85}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">“</span><span class="NormalTextRun SCXW13732284 BCX0">Improved risk stratification beyond conventional symptom-based assessment might therefore be needed to better inform clinical decision-making in asymptomatic severe AS.</span><span class="NormalTextRun SCXW13732284 BCX0">”</span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="1438354940" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{20}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">The current study therefore set out to investigate the merit of a novel clinical presentation framework recently set out for AS</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>which classifies</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>patients into stable valve syndrome (SVS), progressive valve syndrome (PVS)<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">or</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>acute valve syndrome (AVS)</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>using both clinical presentation and objective disease progression markers.</span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="1948633774" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{22}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">The<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW13732284 BCX0">multicenter</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>(21-site)</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>Japanese</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>CURRENT AS Registry-2</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>included<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">2,824</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>consecutive patients<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">with</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>severe<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">AS</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>during the enrolment period from April 2018 to December 2020</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>and data available on<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">natriuretic peptide (NP) and left ventricular ejection fraction (LVEF)</span><span class="NormalTextRun SCXW13732284 BCX0">.</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>Severe AS was defined as<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">a peak aortic jet velocity >4.0 m/s, a mean transaortic pressure gradient >40 mmHg, or an aortic valve area</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span><1 cm</span></span><span class="NormalTextRun Superscript SCXW13732284 BCX0" data-fontsize="11">2</span><span class="NormalTextRun SCXW13732284 BCX0">.</span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="199886153" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{24}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">Patients with<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">prior history of surgical aortic valve replacement, transcatheter aortic valve replacement, or percutaneous aortic balloon valvuloplasty</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>were excluded. </span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="1779174246" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{26}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">The 2,824 were</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>defined by<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">three categories</span><span class="NormalTextRun SCXW13732284 BCX0">:</span><span> </span><span class="NormalTextRun SCXW13732284 BCX0">455 in<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">SVS</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>(no symptoms and low NP)</span><span class="NormalTextRun SCXW13732284 BCX0">, 1,078 in PVS<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">(mild symptoms and/or mildly elevated NP)<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">and 1,291 in AVS</span><span> </span><span class="NormalTextRun SCXW13732284 BCX0">(acute deterioration and/ or markedly elevated NP or reduced LVEF)</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>and were stratified by<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">initial AVR and conservative strategies.</span><span> </span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="526312109" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{28}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">In the three groups,<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">33% of the SVS cohort received<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">initial intervention via surgical or transcatheter aortic valve replacement (SAVR/TAVR) vs 63% of</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>PVS and<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">64% of</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>AVS</span><span class="NormalTextRun SCXW13732284 BCX0">. The<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">remainder</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>received a conservative<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">non-interventional<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">strategy</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>(67% in SVS vs 37% in PVS vs<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">36% in AVS).</span><span class="NormalTextRun SCXW13732284 BCX0"> </span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="1607644880" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{30}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">B</span><span class="NormalTextRun SCXW13732284 BCX0">aseline clinical and echocardiographic characteristics differed<span> </span></span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW13732284 BCX0">substantially</span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW13732284 BCX0">.</span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW13732284 BCX0">.</span><span> </span><span class="NormalTextRun SCXW13732284 BCX0">Patients with AVS were more<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">frequently</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>men</span><span> </span><span class="NormalTextRun SCXW13732284 BCX0">(42% vs 38% in PVS vs 35% in SVS)</span><span class="NormalTextRun SCXW13732284 BCX0">, older</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>(mean age 83.2 years vs 81.1 years vs 78.8 years</span><span class="NormalTextRun SCXW13732284 BCX0">, respectively</span><span class="NormalTextRun SCXW13732284 BCX0">; P = 0.04)</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>and had a higher prevalence of cardiovascular comorbidities</span><span class="NormalTextRun SCXW13732284 BCX0">.</span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="1237802571" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{34}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">Compared to the SVS patients,<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">those in<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">AVS also had</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>more advanced frailty<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">(11%<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">scored as 7 to 9 vs 2% in SVS)</span><span class="NormalTextRun SCXW13732284 BCX0">,</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>higher surgical risk scores</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>and<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">markedly<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">greater b</span><span class="NormalTextRun SCXW13732284 BCX0">aseline levels of</span><span> </span><span class="NormalTextRun SCXW13732284 BCX0">NP.</span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="1169985128" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{36}"><strong><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun MacChromeBold SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">Close surveillance </span><span class="NormalTextRun SCXW13732284 BCX0">feasible</span><span class="NormalTextRun SCXW13732284 BCX0"> in</span><span class="NormalTextRun SCXW13732284 BCX0"> select</span><span class="NormalTextRun SCXW13732284 BCX0"> patients</span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></strong></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="1546220001" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{38}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">For the patients given an initial aortic valve replacement<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">instead of watchful management, AVS was associated with higher risk of the primary outcome<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">—</span><span> </span><span class="NormalTextRun SCXW13732284 BCX0">a composite of death or heart failure hospitalization</span><span> </span><span class="NormalTextRun SCXW13732284 BCX0">—</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>than SVS<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">(adjusted</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>hazard ratio [</span><span class="NormalTextRun SCXW13732284 BCX0">HR</span><span class="NormalTextRun SCXW13732284 BCX0">]:</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>2.34; 95%<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">confidence interval [</span><span class="NormalTextRun SCXW13732284 BCX0">CI</span><span class="NormalTextRun SCXW13732284 BCX0">]:</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>1.19–4.59; P=0.01)</span><span class="NormalTextRun SCXW13732284 BCX0">. However, PVS was not. </span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="165490919" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{40}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">SVS p</span><span class="NormalTextRun SCXW13732284 BCX0">atients<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">with a conservative treatment approach<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">(no intervention initially) demonstrated a “very low” early event rate, meanwhile (1% at 6 months)</span><span class="NormalTextRun SCXW13732284 BCX0">, while AVS and PVS both carried higher risk<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">(AVS<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW13732284 BCX0">aHR</span><span class="NormalTextRun SCXW13732284 BCX0">:</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>4.08</span><span class="NormalTextRun SCXW13732284 BCX0">;</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>95% CI</span><span class="NormalTextRun SCXW13732284 BCX0">:</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>2.65-6.31</span><span class="NormalTextRun SCXW13732284 BCX0">;</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>P</span><span class="NormalTextRun SCXW13732284 BCX0"><0.001</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>vs PVS<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW13732284 BCX0">aHR</span><span class="NormalTextRun SCXW13732284 BCX0">:</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>2.23</span><span class="NormalTextRun SCXW13732284 BCX0">;</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>95% CI</span><span class="NormalTextRun SCXW13732284 BCX0">:</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>1.45-3.43</span><span class="NormalTextRun SCXW13732284 BCX0">;</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>P<0.001</span><span class="NormalTextRun SCXW13732284 BCX0">).</span><span class="NormalTextRun SCXW13732284 BCX0"> </span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="694469877" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{42}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">This<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">support</span><span class="NormalTextRun SCXW13732284 BCX0">s</span><span> </span><span class="NormalTextRun SCXW13732284 BCX0">“</span><span class="NormalTextRun SCXW13732284 BCX0">the feasibility of close surveillance in carefully selected patients</span><span class="NormalTextRun SCXW13732284 BCX0">,” the researchers</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>noted</span><span class="NormalTextRun SCXW13732284 BCX0">.<span> </span></span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="1370878192" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{44}"><strong><span class="NormalTextRun SCXW13732284 BCX0">Further stratification</span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></strong></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="1576257787" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{47}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">A subgroup analysis of the patients further classified them into five phenotypes</span><span class="NormalTextRun SCXW13732284 BCX0">:</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>SVS,<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">progressive valve signs without symptoms, progressive valve symptoms, acute valve signs without symptoms</span><span> </span><span class="NormalTextRun SCXW13732284 BCX0">and acute valve symptoms</span><span class="NormalTextRun SCXW13732284 BCX0">.<span> </span></span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="113740655" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{49}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">In that analysis,<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">patients with progressive valve signs without symptoms underwent AVR at rates comparable to<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">SVS</span><span class="NormalTextRun SCXW13732284 BCX0">,</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>yet</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>had worse outcomes than SVS in the conservative stratum (adjusted HR 1.89; 95% CI 1.18-3.03; P=0.008).</span><span class="NormalTextRun SCXW13732284 BCX0">“</span><span class="NormalTextRun SCXW13732284 BCX0">M</span><span class="NormalTextRun SCXW13732284 BCX0">eticulous clinical surveillance strategy might remain<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">a viable</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>option, particularly in carefully selected patients with SVS, given the low early event rate including the absence of sudden death within 6 months after diagnosis under conservative management</span><span class="NormalTextRun SCXW13732284 BCX0">,” the researchers concluded.</span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="984027339" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{55}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">“</span><span class="NormalTextRun SCXW13732284 BCX0">Notably, by 1 year, 20% of patients with SVS in the conservative stratum underwent SAVR or TAVR, largely without preceding acute HF hospitalization, suggesting that close surveillance enabled timely referral for valve intervention before overt decompensation in this subgroup.</span><span class="NormalTextRun SCXW13732284 BCX0">”</span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="948705396" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{57}"><strong><span class="NormalTextRun SCXW13732284 BCX0">Source:</span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></strong></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" paraid="1339134758" paraeid="{3c2ea220-fcd4-4fd2-8274-109a4231a3cf}{59}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">Taniguchi</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>T</span><span class="NormalTextRun SCXW13732284 BCX0">, Morimoto T,<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW13732284 BCX0">Takeji</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>Y, et a</span><span class="NormalTextRun SCXW13732284 BCX0">l.<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">Stable, Progressive, and Acute Valve Syndrome in Severe Aortic Stenosis: Insights from the CURRENT AS Registry-2.</span><span> </span></span><em><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">J</span><span class="NormalTextRun SCXW13732284 BCX0"> Am </span><span class="NormalTextRun SCXW13732284 BCX0">Heart Assoc.</span></span></em><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>2026</span><span class="NormalTextRun SCXW13732284 BCX0"><span> </span>June</span><span class="NormalTextRun SCXW13732284 BCX0">; DOI:<span> </span></span><span class="NormalTextRun SCXW13732284 BCX0">10.1161/JAHA.126.050490</span><span class="NormalTextRun SCXW13732284 BCX0">.</span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW13732284 BCX0"> <p class="Paragraph SCXW13732284 BCX0" lang="EN-US" paraid="1368342952" paraeid="{db313403-c467-4bb7-9092-a7086831003a}{164}"><strong><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun MacChromeBold SCXW13732284 BCX0"><span class="NormalTextRun SCXW13732284 BCX0">Image Credit: </span><span class="NormalTextRun SpellingErrorV2Themed SCXW13732284 BCX0">syahrir</span> <span class="NormalTextRun SCXW13732284 BCX0">– stock.adobe.com</span></span><span class="EOP Selected SCXW13732284 BCX0" data-ccp-props="{}"> </span></strong></p> </div>