Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Theresa McDonagh, King's College London
- Second opponent: Professor Alf Inge Larsen, Stavanger University Hospital
- Third member and chair of the evaluation committee: Professor II Dan Atar, University of Oslo
Chair of the Defence
Associate Professor Are Martin Holm, University of Oslo
Principal Supervisor
Senior Consultant Kaspar Broch, Oslo University Hospital
Summary
Degenerative aortic stenosis is the most prevalent valvular heart disease in Europe and North-America and a major burden for morbidity, mortality, and health care costs. In this thesis entitled “Aortic stenosis – iron deficiency, diastolic dysfunction, and outcomes” Anette Borger Kvaslerud and co-authors present the results of four studies that aim to investigate aspects of the management of severe aortic stenosis where there are still many unanswered questions. The first part of the thesis focuses on patients with severe aortic stenosis who are asymptomatic. In the first paper, they show that patients who were advised against valve intervention due to a lack of symptoms between 2002-2016 had a higher mortality rate than those who received aortic valve replacement. These results question the current management strategy of watchful waiting in this population. In paper two, 50 patients with asymptomatic severe aortic stenosis were examined with right heart catheterisation to assess the extent of exercise induced pulmonary hypertension due to left heart disease. They found that 45/50 patients had an abnormal hemodynamic response to exercise, suggesting that incipient heart failure is present in most of these patients.
In the second part of the thesis, the prevalence and prognostic implications of iron deficiency in patients with severe aortic stenosis were assessed. In the third study, a prospective cohort study on 464 patients referred for aortic valve replacement, the prevalence of iron deficiency was 53 % (iron deficiency: ferritin < 100 µg/L or ferritin between 100 and 299 µg/L with transferrin saturation < 20 %). Although patients with iron deficiency had an overall worse clinical profile there was no association between iron deficiency and the risk of morbidity or mortality during follow-up. Finally, the fourth article presents the results of the IIISAS trial that randomised 149 patients with severe aortic stenosis and iron deficiency to intravenous ferric derisomaltose or placebo. Iron stores were restored in 76 % vs. 13 %, but no difference across study arms was found in the baseline-adjusted six-minute walk distance, which was the primary endpoint of the trial. Nor was there any difference in the secondary endpoints NYHA class, quality of life, and hand grip strength.
Additional information
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