Background Cardiac damage (CD) significantly affects the prognosis of patients with aortic stenosis (AS).Objectives The aim of this study was to investigate the impact of CD on long-term survival in patients with moderate and severe AS.Methods In a pooled analysis of 2 single-center registries, patients with moderate or severe AS were included according to the presence of early (stages 0 and 1) or advanced (stages 2-4) CD.Results Among 1,096 patients with AS included between 2009 and 2023, 626 patients (mean age 78.9 ± 8.0 years, 33.1% women) had moderate (n = 343) or severe AS (n = 283). Advanced CD was present in 497 patients (79.4%), and the median follow-up duration was 7.4 years (Q1-Q3: 4.2-10.6 years). There was a gradual increase in the risk for 10-year mortality from moderate to severe AS and from early CD (moderate AS: reference; severe AS: adjusted HR [aHR]: 1.42; 95% CI: 0.75-2.72) to advanced CD (moderate AS: aHR: 1.91; 95% CI: 1.22-2.97; severe AS: aHR: 2.77; 95% CI: 1.73-4.45). At a median 347 days, 344 patients (54.9%) had undergone aortic valve replacement (AVR). In patients with advanced CD, AVR was associated with lower mortality compared with conservative management, irrespective of AS severity (moderate AS: aHR: 0.43; 95% CI: 0.28-0.66; severe AS: aHR: 0.27; 95% CI: 0.18-0.39). In patients with early CD, AVR was associated with lower mortality in patients with severe AS (aHR: 0.29; 95% CI: 0.10-0.86), but not in those with moderate AS (aHR: 0.61; 95% CI: 0.25-1.44).Conclusions Ten-year mortality in patients with moderate and severe AS is importantly determined by CD extent. AVR was associated with lower mortality in patients with moderate AS and advanced CD.
