Screening Tool to Identify Patients with Advanced Aortic Valve Stenosis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Population and Data Source
2.2. Analytic Cohort Building
2.3. Moderate and Severe AS
2.4. Predictor Variables
2.5. Variable Selection and Model Development
2.6. Performance Metrics
2.7. Clinical Interpretability
3. Results
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Hypertension | I10, I11, I11.0, I11.9, I12, I12.0, I12.9, I13, I13.0, I13.1, I13.10, I13.11, I13.2, I15, I15.0, I15.1, I15.2, I15.8, I15.9 |
Coronary Heart Disease | I20, I20.0, I20.1, I20.8, I20.9, I21, I21.0, I21.01, I21.02, I21.09, I21.1, I21.11, I21.19, I21.2, I21.21, I21.29, I21.3, I21.4, I21.9, I24.8, I24.9, I25, I25.1, I25.10, I25.11, I25.11, I25.110, I25.111, I25.118, I25.119, I25.2, I25.3, I25.5, I25.6, I25.8, I25.81, I25.82, I25.83, I25.84, I25.89 |
Dyslipidemia | E78, E78.0, E78.00, E78.01, E78.1, E78.2, E78.3, E78.4, E78.41, E78.49, E78.5, E78.6 |
Pulmonary Hypertension | I27.0, I27.2, I27.20, I27.21, I27.22, I27.23, I27.24, I27.29, I27.81 |
Endocarditis | I33.0, I33.9, I38, I39 |
Mitral Regurgitation | I34.0, I34.1, I34.8, I34.9 |
Aortic Stenosis | I35.0, I35.2 |
Tricuspid Regurgitation | I36.1, I36.8, I36.9 |
Cardiomyopathy | I42.0, I42.1, I42.2 |
Heart Block | I44.0, I44.1, I44.2, I44.30, I44.39, I44.4, I44.5, I44.60, I44.69, I44.7, I45.0, I45.10, I45.19, I45.2, I45.3, I45.4, I45.6, I45.81, I45.89, I45.9 |
Cardiac Arrest | I46.2, I46.8, I46.9 |
Atrial Fibrillation | I48.0, I48.1, I48.11, I48.19, I48.2, I48.20, I48.21, I48.91, I48.3, I48.4, I48.92, I49.5 |
Heart Failure | I11.0, I13.0, I13.1, I13.10, I13.11, I13.2, I50.1, I50.2, I50.20, I50.21, I50.22, I50.23, I50.3, I50.30, I50.31, I50.32, I50.33, I50.4, I50.40, I50.41, I50.42, I50.43, I50.8, I50.81, I50.810, I50.811, I50.812, I50.813, I50.814, I50.82, I50.84, I50.9 |
Stroke | I60, I60.0, I60.00, I60.01, I60.02, I60.1, I60.10, I60.11, I60.12, I60.2, I60.3, I60.30, I60.31, I60.32, I60.4, I60.5, I60.50, I60.51, I60.52, I60.6, I60.6, I60.7, I60.8, I60.9, I61, I61.0, I61.1, I61.2, I61.3, I61.4, I61.5, I61.6, I61.8, I61.9, I62, I62.0, I62.00, I62.01, I62.02, I62.03, I62.1, I62.9, I63, I63.0, I63.00, I63.01, I63.011, I63.012, I63.013, I63.019, I63.03, I63.031, I63.032, I63.033, I63.039, I63.09, I63.1, I63.10, I63.11, I63.111, I63.112, I63.113, I63.119, I63.12, I63.13, I63.131, I63.132, I63.133, I63.139, I63.19, I63.2, I63.20, I63.21, I63.211, I63.212, I63.213, I63.219, I63.22, I63.23, I63.231, I63.232, I63.233, I63.239, I63.29, I63.3, I63.30, I63.31, I63.311, I63.312, I63.313, I63.319, I63.32, I63.321, I63.322, I63.323, I63.329, I63.33, I63.331, I63.332, I63.333, I63.339, I63.34, I63.341, I63.342, I63.343, I63.349, I63.39, I63.4, I63.40, I63.41, I63.411, I63.412, I63.413, I63.419, I63.42, I63.421, I63.422, I63.423, I63.429, I63.43, I63.431, I63.432, I63.433, I63.439, I63.44, I63.441, I63.442, I63.443, I63.449, I63.49, I63.5, I63.50, I63.51, I63.511, I63.512, I63.513, I63.519, I63.52, I63.521, I63.522, I63.523, I63.529, I63.53, I63.531, I63.532, I63.533, I63.539, I63.54, I63.541, I63.542, I63.543, I63.549, I63.59, I63.6, I63.8, I63.81,I63.89, I63.9 |
Cerebrovascular Disease | I65.0, I65.01, I65.02, I65.03, I65.09, I65.1, I65.2, I65.21, I65.22, I65.23, I65.29, I65.8, I66, I66.0, I66.01, I66.02, I66.03, I66.09, I66.1, I66.11, I66.12, I66.13, I66.19, I66.2, I66.21, I66.22, I66.23, I66.29, I66.3, I66.8, I66.9, I67, I67.0, I67.1, I67.2, I67.3, I67.4, I67.5, I67.6, I67.7, I67.8, I67.81, I67.82, I67.83, I67.84, I67.9 |
Peripheral Vascular Disease | I73.9, I73.89, E08.5, E09.5, E10.5, E11.5, E13.5, I70.20, I70.21, I70.22, I70.26, I70.29, I70.23, I70.24, I70.25, I70.211, I70.212, I70.213, I70.218, I70.311, I70.312, I70.313, I70.318, I70.611 |
Chronic Lung Disease | J40, J41, J41.0, J41.1, J41.8, J42, J43, J43.9, J44, J44.0, J44.1, J44.9, J45, J45.2, J45.20, J45.21, J45.22, J45.3, J45.30, J45.31, J45.32, J45.4, J45.40, J45.41, J45.42, J45.5, J45.50, J45.51, J45.52, J45.9, J45.90, J45.901, J45.902, J45.909, J45.99, J45.990, J45.991, J45.998, J47, J47.0, J47.1, J47.9 |
Chronic Kidney Disease | N18, N18.1, N18.2, N18.3, N18.4, N18.5, N18.6, N18.9, N19 |
Diabetes Mellitus | E10, E11, E11.2, E11.21, E11.22, E11.29, E11.3, E11.31, E11.39, E11.32, E11.321, E11.329, E11.33, E11.331, E11.339, E11.34, E11.341, E11.349, E11.35, E11.351, E11.352, E11.353, E11.354, E11.355, E11.359, E11.36, E11.37, E11.39, E11.4, E11.40, E11.41, E11.42, E11.43, E11.44, E11.49, E11.5, E11.51, E11.52, E11.59, E11.6, E11.61, E11.610, E11.618, E11.62, E11.620, E11.621, E11.622, E11.628, E11.63, E11.630, E11.638, E11.64, E11.641, E11.649, E11.65, E11.69, E11.8, E11.9, E13 |
Chronic Liver Disease/Cirrhosis | K70, K70.0, K70.1, K70.10, K70.11, K70.2, K70.3, K70.30, K70.31, K70.4, K70.40, K70.41, K70.9, K72.1, K72.10, K72.11, K72.9, K72.90, K72.91, K73, K73.0, K73.1, K73.2, K73.8, K73.9, K74, K74.0, K74.1, K74.2, K74.3, K74.4, K74.5, K74.6, K74.60, K74.69, K74.5, K75.9, K76.1, K76.9 |
Dementia | F01, F01.5, F01.50, F02, F02.8, F02.80, F02.81, F03, F03.9, F03.90, F03.91, F04 |
Frailty | R54, R53.0, R53.1, R53.2, R53.8, R53.81, R53.82, R41.81, R53.83 |
Inability to Walk | R26, R26.0, R26.1, R26.2, R26.8, R26.9, R27, R27.0, R27.8, R27.9, R29.3, R29.4, R29.6 |
Depression | F32, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.9, F33, F33.0, F33.1, F33.2, F33.3, F33.4, F33.40, F33.41, F33.42, F33.8, F33.9 |
Malnutrition | E40, E41, E42, E43, E44, E44.0, E44.1, E45, E46 |
Obesity | E66, E66.0, E66.01, E66.09, E66.1, E66.2, E66.3, E66.8, E66.9 |
References
- Nathaniel, S.; Saligram, S.; Innasimuthu, A.L. Aortic stenosis: An update. World J. Cardiol. 2010, 2, 135–139. [Google Scholar] [CrossRef]
- Beydoun, H.A.; Beydoun, M.A.; Liang, H.; Dore, G.A.; Shaked, D.; Zonderman, A.B.; Eid, S.M. Sex, Race, and Socioeconomic Disparities in Patients With Aortic Stenosis (from a Nationwide Inpatient Sample). Am. J. Cardiol. 2016, 118, 860–865. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Osnabrugge, R.L.; Mylotte, D.; Head, S.J.; Van Mieghem, N.M.; Nkomo, V.T.; LeReun, C.M.; Bogers, A.J.; Piazza, N.; Kappetein, A.P. Aortic stenosis in the elderly: Disease prevalence and number of candidates for transcatheter aortic valve replacement: A meta-analysis and modeling study. J. Am. Coll. Cardiol. 2013, 62, 1002–1012. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tang, L.; Gössl, M.; Ahmed, A.; Garberich, R.; Bradley, S.M.; Niikura, H.; Witt, D.; Pedersen, W.R.; Bae, R.; Lesser, J.R.; et al. Contemporary Reasons and Clinical Outcomes for Patients with Severe, Symptomatic Aortic Stenosis Not Undergoing Aortic Valve Replacement. Circ. Cardiovasc. Interv. 2018, 11, e007220. [Google Scholar] [CrossRef] [PubMed]
- Ziaeian, B.; Fonarow, G.C. Epidemiology and aetiology of heart failure. Nat. Rev. Cardiol. 2016, 13, 368–378. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kapadia, S.R.; Leon, M.B.; Makkar, R.R.; Miller, C.; Moses, W.J.; Cleveland, C.C.; Douglas, P.S.; Anderson, W.N.; Blackstone, E.H.; Kodali, S.K.; et al. 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): A randomised controlled trial. Lancet 2015, 385, 2485–2491. [Google Scholar] [CrossRef]
- Brown, J.M.; O’Brien, S.M.; Wu, C.; Sikora, J.A.; Griffith, B.P.; Gammie, J.S. Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: Changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database. J. Thorac. Cardiovasc. Surg. 2009, 137, 82–90. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Chiang, S.J.; Daimon, M.; Miyazaki, S.; Kawata, T.; Morimoto-Ichikawa, R.; Maruyama, M.; Ohmura, H.; Miyauchi, K.; Lee, S.L.; Daida, H. When and how aortic stenosis is first diagnosed: A single-center observational study. J. Cardiol. 2016, 68, 324–328. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Pellikka, P.A.; Sarano, M.E.; Nishimura, R.A.; Malouf, J.F.; Bailey, K.R.; Scott, C.G.; Barnes, M.E.; Tajik, A.J. Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up. Circulation 2005, 111, 3290–3295. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Généreux, P.; Stone, G.W.; O’Gara, P.T.; Marquis-Gravel, G.; Redfors, B.; Giustino, G.; Pibarot, P.; Bax, J.J.; Bonow, R.O.; Leon, M.B. Natural History, Diagnostic Approaches, and Therapeutic Strategies for Patients with Asymptomatic Severe Aortic Stenosis. J. Am. Coll. Cardiol. 2016, 67, 2263–2288. [Google Scholar] [CrossRef]
- Baumgartner, H.; Hung, J.; Bermejo, J.; Chambers, J.B.; Edvardsen, T.; Goldstein, S.; Lancellotti, P.; LeFevre, M.; Miller, F.; Otto, C.M. Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis: A Focused Update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J. Am. Soc. Echocardiogr. 2017, 30, 372–392. [Google Scholar] [CrossRef] [PubMed]
- Secretariat, M.A. Ultrasound screening for abdominal aortic aneurysm: An evidence-based analysis. Ont. Health Technol. Assess Ser. 2006, 6, 1–67. [Google Scholar]
- US Preventive Services Task Force. Screening for abdominal aortic aneurysm: Recommendation statement. Ann. Intern. Med. 2005, 142, 198–202. [Google Scholar] [CrossRef] [Green Version]
- Criss, S.D.; Cao, P.; Bastani, M.; Ten Haaf, K.; Chen, Y.; Sheehan, D.F.; Blom, E.F.; Toumazis, I.; Jeon, J.; de Koning, H.J.; et al. Cost-Effectiveness Analysis of Lung Cancer Screening in the United States: A Comparative Modeling Study. Ann. Intern. Med. 2019, 171, 796–804. [Google Scholar] [CrossRef] [PubMed]
- Shen, M.; Tastet, L.; Capoulade, R.; Arsenault, M.; Bédard, E.; Clavel, M.-A.; Pibarot, P. Effect of bicuspid aortic valve phenotype on progression of aortic stenosis. Eur. Heart J. Cardiovasc. Imaging 2020, 21, 727–734. [Google Scholar] [CrossRef] [PubMed]
- Vavilis, G.; Bäck, M.; Occhino, G.; Trevisan, M.; Bellocco, R.; Evans, M.; Lindholm, B.; Szummer, K.; Carrero, J.J. Kidney Dysfunction and the Risk of Developing Aortic Stenosis. J. Am. Coll. Cardiol. 2019, 73, 305–314. [Google Scholar] [CrossRef] [PubMed]
- Patel, D.K.; Green, K.D.; Fudim, M.; Harrell, F.E.; Wang, T.J.; Robbins, M.A. Racial differences in the prevalence of severe aortic stenosis. J. Am. Heart Assoc. 2014, 3, e000879. [Google Scholar] [CrossRef] [Green Version]
- Owens, D.S.; Katz, R.; Takasu, J.; Kronmal, R.; Budoff, M.J.; O’Brien, K.D. Incidence and progression of aortic valve calcium in the Multi-ethnic Study of Atherosclerosis (MESA). Am. J. Cardiol. 2010, 105, 701–708. [Google Scholar] [CrossRef] [Green Version]
Potential Predictor | No AS (n = 31,304) | Moderate/Severe AS (n = 4200) | |||||
---|---|---|---|---|---|---|---|
Mean/Number | SD/% | Mean/Number | SD/% | p-Value | |||
Age (years) | 66.4 | 13.3 | 76.6 | 11.3 | <0.0001 | ||
Gender | |||||||
Male | 15,935 | 50.9 | 2220 | 52.9 | |||
Female | 15,369 | 49.1 | 1980 | 47.1 | 0.017 | ||
Race/ethnicity | |||||||
Caucasian | 22,711 | 72.6 | 3607 | 85.9 | |||
African American | 5460 | 17.4 | 324 | 7.7 | |||
Other race | 3133 | 10.0 | 269 | 6.4 | <0.0001 | ||
BMI (kg/m2) | |||||||
<18.5 | 1258 | 4.0 | 153 | 3.6 | |||
18.5–24.9 | 8921 | 28.5 | 1378 | 32.8 | |||
25–29.9 | 9482 | 30.3 | 1260 | 30.0 | |||
≥30 | 11,475 | 36.7 | 1409 | 33.6 | <0.0001 | ||
Smoking | |||||||
No | 21,828 | 69.7 | 2947 | 70.2 | |||
Yes | 9476 | 30.3 | 1253 | 29.8 | 0.56 | ||
Medication | |||||||
Aspirin | |||||||
No | 8801 | 28.1 | 1110 | 26.4 | |||
Yes | 16,834 | 53.8 | 2877 | 68.5 | |||
Missing | 5669 | 18.1 | 213 | 5.1 | <0.0001 | ||
Statins | |||||||
No | 10,336 | 33.0 | 1207 | 28.7 | |||
Yes | 15,299 | 48.9 | 2780 | 66.2 | |||
Missing | 5669 | 18.1 | 213 | 5.1 | <0.0001 | ||
Beta-blockers | |||||||
No | 17,073 | 54.5 | 1663 | 39.6 | |||
Yes | 14,231 | 45.5 | 2537 | 60.4 | <0.0001 | ||
CCB | |||||||
No | 20,346 | 65.0 | 2253 | 53.6 | |||
Yes | 10,958 | 35.0 | 1947 | 46.4 | <0.0001 | ||
ACEI | |||||||
No | 23,077 | 73.7 | 2972 | 70.8 | |||
Yes | 8227 | 26.3 | 1228 | 29.2 | <0.0001 | ||
Diuretic | |||||||
No | 17,593 | 56.2 | 1383 | 32.9 | |||
Yes | 13,711 | 43.8 | 2817 | 67.1 | <0.0001 | ||
Comorbidity | |||||||
CABG | |||||||
No | 29,445 | 94.1 | 3565 | 84.9 | |||
Yes | 1859 | 5.9 | 635 | 15.1 | <0.0001 | ||
PCI | |||||||
No | 28,762 | 91.9 | 3694 | 88.0 | |||
Yes | 2542 | 8.1 | 506 | 12.1 | <0.0001 | ||
Hypertension | |||||||
No | 10,977 | 35.1 | 899 | 21.4 | |||
Yes | 20,327 | 64.9 | 3301 | 78.6 | <0.0001 | ||
CAD | |||||||
No | 23,597 | 75.4 | 2461 | 58.6 | |||
Yes | 7707 | 24.6 | 1739 | 41.4 | <0.0001 | ||
Dyslipidemia | |||||||
No | 17,266 | 55.2 | 1683 | 40.1 | |||
Yes | 14,038 | 44.8 | 2517 | 59.9 | <0.0001 | ||
Pulmonary hypertension | |||||||
No | 30,734 | 98.2 | 4031 | 96.0 | |||
Yes | 570 | 1.8 | 169 | 4.0 | <0.0001 | ||
Cardiomyopathy | |||||||
No | 31,192 | 99.6 | 4172 | 99.3 | |||
Yes | 112 | 0.4 | 28 | 0.7 | 0.0027 | ||
HB | |||||||
No | 30,131 | 96.3 | 3858 | 91.9 | |||
Yes | 1173 | 3.8 | 342 | 8.1 | <0.0001 | ||
Cardiac arrest | |||||||
No | 31,173 | 99.6 | 4178 | 99.5 | |||
Yes | 131 | 0.4 | 22 | 0.5 | 0.33 | ||
AF | |||||||
No | 26,161 | 83.6 | 2912 | 69.3 | |||
Yes | 5143 | 16.4 | 1288 | 30.7 | <0.0001 | ||
ICH | |||||||
No | 30,877 | 98.6 | 4163 | 99.1 | |||
Yes | 427 | 1.4 | 37 | 0.9 | 0.0096 | ||
Cerebral infarction | |||||||
No | 27,631 | 88.3 | 3621 | 86.2 | |||
Yes | 3673 | 11.7 | 579 | 13.8 | 0.0001 | ||
CVD | |||||||
No | 30,657 | 97.9 | 4046 | 96.3 | |||
Yes | 647 | 2.1 | 154 | 3.7 | <0.0001 | ||
PVD | |||||||
No | 29,756 | 95.1 | 3746 | 89.2 | |||
Yes | 1548 | 5.0 | 454 | 10.8 | <0.0001 | ||
Chronic lung disease | |||||||
No | 24,087 | 77.0 | 3178 | 75.7 | |||
Yes | 7217 | 23.1 | 1022 | 24.3 | 0.065 | ||
CKD | |||||||
No | 28,512 | 91.1 | 3526 | 84.0 | |||
Yes | 2792 | 8.9 | 674 | 16.1 | <0.0001 | ||
DM | |||||||
No | 23,016 | 73.5 | 2805 | 66.8 | |||
Yes | 8288 | 26.5 | 1395 | 33.2 | <0.0001 | ||
Chronic liver disease | |||||||
No | 30,135 | 96.3 | 4034 | 96.1 | |||
Yes | 1169 | 3.7 | 166 | 4.0 | 0.49 | ||
Dementia | |||||||
No | 30,139 | 96.3 | 3975 | 94.6 | |||
Yes | 1165 | 3.7 | 225 | 5.4 | <0.0001 | ||
Frailty | |||||||
No | 30,902 | 98.7 | 4155 | 98.9 | |||
Yes | 402 | 1.3 | 45 | 1.1 | 0.25 | ||
Inability to walk | |||||||
No | 30,946 | 98.9 | 4134 | 98.4 | |||
Yes | 358 | 1.1 | 66 | 1.6 | 0.017 | ||
Depression | |||||||
No | 26,505 | 84.7 | 3690 | 87.9 | |||
Yes | 4799 | 15.3 | 510 | 12.1 | <0.0001 | ||
Malnutrition | |||||||
No | 31,213 | 99.7 | 4192 | 99.8 | |||
Yes | 91 | 0.3 | 8 | 0.2 | 0.25 | ||
Obesity | |||||||
No | 28,989 | 92.6 | 3885 | 92.5 | |||
Yes | 2315 | 7.4 | 315 | 7.5 | 0.8100 | ||
Pacemaker | |||||||
No | 30,657 | 97.9 | 3984 | 94.9 | |||
Yes | 647 | 2.1 | 216 | 5.1 | <0.0001 | ||
Defibrillator | |||||||
No | 30,688 | 98.0 | 4078 | 97.1 | |||
Yes | 616 | 2.0 | 122 | 2.9 | <0.0001 | ||
HF | |||||||
No | 28,373 | 90.6 | 3333 | 79.4 | |||
Yes | 2931 | 9.4 | 867 | 20.6 | <0.0001 |
Predictor | Moderate/Severe AS | |||||
---|---|---|---|---|---|---|
β Coefficient | p-Value | OR | 95% CI | |||
Age (every 1-year increment from 40) | 0.0535 | <0.0001 | 1.055 | 1.051–1.059 | ||
Gender | ||||||
Male | 0.0862 | 0.019 | 1.09 | 1.01–1.17 | ||
Female | ref. | 1.00 | ||||
Race/ethnicity | ||||||
Caucasian | ref. | 1.00 | ||||
African American | −0.7024 | <0.0001 | 0.50 | 0.44–0.56 | ||
Others | −0.1900 | 0.0067 | 0.83 | 0.72–0.95 | ||
BMI (kg/m2) | ||||||
<18.5 | −0.2033 | 0.033 | 0.82 | 0.68–0.98 | ||
18.5–24.9 | ref. | 1.00 | ||||
25–29.9 | −0.0106 | 0.81 | 0.99 | 0.91–1.08 | ||
≥30 | 0.1326 | 0.0048 | 1.14 | 1.04–1.25 | ||
Medication | ||||||
Aspirin | ||||||
No | ref. | 1.00 | ||||
Yes | 0.1896 | <0.0001 | 1.21 | 1.11–1.31 | ||
Statins | ||||||
No | ref. | 1.00 | ||||
Yes | 0.0839 | 0.055 | 1.09 | 1.00–1.19 | ||
CCB | ||||||
No | ref. | 1.00 | ||||
Yes | 0.1844 | <0.0001 | 1.20 | 1.12–1.29 | ||
Diuretic | ||||||
No | ref. | 1.00 | ||||
Yes | 0.4545 | <0.0001 | 1.58 | 1.46–1.70 | ||
Comorbidity | ||||||
CABG | ||||||
No | ref. | 1.00 | ||||
Yes | 0.3140 | <0.0001 | 1.37 | 1.22–1.53 | ||
HTN | ||||||
No | ref. | 1.00 | ||||
Yes | 0.0806 | 0.074 | 1.08 | 0.99–1.18 | ||
CAD | ||||||
No | ref. | 1.00 | ||||
Yes | 0.1301 | 0.0022 | 1.14 | 1.05–1.24 | ||
Dyslipidemia | ||||||
No | ref. | 1.00 | ||||
Yes | 0.2028 | <0.0001 | 1.23 | 1.13–1.32 | ||
Pulmonary hypertension | ||||||
No | ref. | 1.00 | ||||
Yes | 0.5233 | <0.0001 | 1.69 | 1.39–2.04 | ||
Cardiomyopathy | ||||||
No | ref. | 1.00 | ||||
Yes | 0.5537 | 0.015 | 1.74 | 1.12–2.71 | ||
Heart block | ||||||
No | ref. | 1.00 | ||||
Yes | 0.2679 | 0.0001 | 1.31 | 1.14–1.50 | ||
AF | ||||||
No | ref. | 1.00 | ||||
Yes | 0.1367 | 0.0009 | 1.15 | 1.06–1.24 | ||
ICH | ||||||
No | ref. | 1.00 | ||||
Yes | −0.4918 | 0.0062 | 0.61 | 0.43–0.87 | ||
CVD | ||||||
No | ref. | 1.00 | ||||
Yes | 0.2135 | 0.029 | 1.24 | 1.02–1.50 | ||
PVD | ||||||
No | ref. | 1.00 | ||||
Yes | 0.2552 | <0.0001 | 1.29 | 1.14–1.46 | ||
CKD | ||||||
No | ref. | 1.00 | ||||
Yes | 0.1836 | 0.0004 | 1.20 | 1.09–1.33 | ||
DM | ||||||
No | ref. | 1.00 | ||||
Yes | 0.0735 | 0.066 | 1.08 | 1.00–1.16 | ||
Chronic liver disease | ||||||
No | ref. | 1.00 | ||||
Yes | 0.4972 | <0.0001 | 1.64 | 1.38–1.97 | ||
Dementia | ||||||
No | ref. | 1.00 | ||||
Yes | −0.3608 | <0.0001 | 0.70 | 0.60–0.81 | ||
Obesity | ||||||
No | ref. | 1.00 | ||||
Yes | 0.1929 | 0.0063 | 1.21 | 1.06–1.39 | ||
Pacemaker | ||||||
No | ref. | 1.00 | ||||
Yes | 0.1799 | 0.040 | 1.20 | 1.01–1.42 | ||
HF | ||||||
No | ref. | 1.00 | ||||
Yes | 0.3256 | <0.0001 | 1.39 | 1.26–1.52 |
Predictor | Moderate/Severe AS | ||||
---|---|---|---|---|---|
β Coefficient | Linear Predictor | Point | |||
Age (every 1-year increment from 40) | 0.0535 | ||||
40–49 | 0.0000 | 0.0 | |||
50–59 | 0.5350 | 20.0 | |||
60–69 | 1.0700 | 40.0 | |||
70–79 | 1.6050 | 60.0 | |||
80–89 | 2.1400 | 80.0 | |||
90+ | 2.6750 | 100.0 | |||
Gender | |||||
Male | 0.0862 | 0.0862 | 3.2 | ||
Female | ref. | 0.0000 | 0.0 | ||
Race/ethnicity | |||||
Caucasian | 0.7024 | 0.7024 | 26.3 | ||
African American | ref. | 0.0000 | 0.0 | ||
Others | 0.5125 | 0.5125 | 19.2 | ||
BMI (kg/m2) | |||||
<18.5 | ref. | 0.0000 | 0.0 | ||
18.5–24.9 | 0.2033 | 0.2033 | 7.6 | ||
25–29.9 | 0.1926 | 0.1926 | 7.2 | ||
≥30 | 0.3359 | 0.3359 | 12.6 | ||
Medication | |||||
Aspirin | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.1896 | 0.1896 | 7.1 | ||
Statins | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.0839 | 0.0839 | 3.1 | ||
CCB | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.1844 | 0.1844 | 6.9 | ||
Diuretic | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.4545 | 0.4545 | 17.0 | ||
Comorbidity | |||||
CABG | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.3140 | 0.3140 | 11.7 | ||
Hypertension | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.0806 | 0.0806 | 3.0 | ||
CAD | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.1301 | 0.1301 | 4.9 | ||
Dyslipidemia | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.2028 | 0.2028 | 7.6 | ||
Pulmonary hypertension | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.5233 | 0.5233 | 19.6 | ||
Dilated cardiomyopathy | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.5537 | 0.5537 | 20.7 | ||
HB | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.2679 | 0.2679 | 10.0 | ||
AFIB | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.1367 | 0.1367 | 5.1 | ||
ICH | |||||
No | 0.4918 | 0.4918 | 18.4 | ||
Yes | ref. | 0.0000 | 0.0 | ||
CVD | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.2135 | 0.2135 | 8.0 | ||
PVD | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.2552 | 0.2552 | 9.5 | ||
CKD | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.1836 | 0.1836 | 6.9 | ||
DM | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.0735 | 0.0735 | 2.7 | ||
Chronic liver disease | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.4972 | 0.4972 | 18.6 | ||
Dementia | |||||
No | 0.3608 | 0.3608 | 13.5 | ||
Yes | ref. | 0.0000 | 0.0 | ||
Obesity | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.1929 | 0.1929 | 7.2 | ||
Pacemaker | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.1799 | 0.1799 | 6.7 | ||
HF | |||||
No | ref. | 0.0000 | 0.0 | ||
Yes | 0.3256 | 0.3256 | 12.2 |
Moderate/Severe AS | ||
---|---|---|
Risk Probability | Linear Predictor | Total Score |
0.0002 | −8.4803 (min) | 0 |
0.01 | −4.5951 | 145 |
0.05 | −2.9444 | 207 |
0.10 | −2.1972 | 235 |
0.15 | −1.7346 | 252 |
0.20 | −1.3863 | 265 |
0.25 | −1.0986 | 276 |
0.30 | −0.8473 | 285 |
0.35 | −0.6190 | 294 |
0.40 | −0.4055 | 302 |
0.45 | −0.2007 | 310 |
0.50 | 0.0000 | 317 |
0.55 | 0.2007 | 325 |
0.60 | 0.4055 | 332 |
0.65 | 0.6190 | 340 |
0.70 | 0.8473 | 349 |
0.75 | 1.0986 | 358 |
0.7711 | 1.2147 (max) | 362 |
Linear predictor for reference level | −8.4803 (β0) | |
Minimum linear predictor | −8.4803 | |
Maximum linear predictor | 1.2147 | |
Scores per unit of linear predictor | 37.3832 | |
Linear predictor units per score | 0.0268 |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Yousef, S.; Amabile, A.; Ram, C.; Huang, H.; Korutla, V.; Singh, S.; Agarwal, R.; Assi, R.; Milewski, R.K.; Zhang, Y.; et al. Screening Tool to Identify Patients with Advanced Aortic Valve Stenosis. J. Clin. Med. 2022, 11, 4386. https://doi.org/10.3390/jcm11154386
Yousef S, Amabile A, Ram C, Huang H, Korutla V, Singh S, Agarwal R, Assi R, Milewski RK, Zhang Y, et al. Screening Tool to Identify Patients with Advanced Aortic Valve Stenosis. Journal of Clinical Medicine. 2022; 11(15):4386. https://doi.org/10.3390/jcm11154386
Chicago/Turabian StyleYousef, Sameh, Andrea Amabile, Chirag Ram, Huang Huang, Varun Korutla, Saket Singh, Ritu Agarwal, Roland Assi, Rita K. Milewski, Yawei Zhang, and et al. 2022. "Screening Tool to Identify Patients with Advanced Aortic Valve Stenosis" Journal of Clinical Medicine 11, no. 15: 4386. https://doi.org/10.3390/jcm11154386
APA StyleYousef, S., Amabile, A., Ram, C., Huang, H., Korutla, V., Singh, S., Agarwal, R., Assi, R., Milewski, R. K., Zhang, Y., Patel, P. A., Krane, M., Geirsson, A., & Vallabhajosyula, P. (2022). Screening Tool to Identify Patients with Advanced Aortic Valve Stenosis. Journal of Clinical Medicine, 11(15), 4386. https://doi.org/10.3390/jcm11154386