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(Circulation. 2009;120:69-75.)
© 2009 American Heart Association, Inc.

Valvular Heart Disease

Risk Score for Predicting Outcome in Patients With Asymptomatic Aortic Stenosis

Jean-Luc Monin, MD, PhD; Patrizio Lancellotti, MD, PhD; Mehran Monchi, MD; Pascal Lim, MD; Emmanuel Weiss, MD; Luc Piérard, MD, PhD; Pascal Guéret, MD

From Assistance Publique-Hôpitaux de Paris, Department of Cardiology, Henri Mondor University Hospital, Créteil, France (J.-L.M., P.L., E.W., P.G.); Department of Intensive Care Medicine, Institut Jacques Cartier, Massy, France (M.M.); and Sart Tilman University Hospital, Liège, Belgium, (P.L., L.P.).

Correspondence to Dr Jean-Luc Monin, Department of Cardiology, Henri Mondor Hospital, 51 avenue De Lattre de Tassigny, 94010 Créteil, France. E-mail jean-luc.monin{at}hmn.aphp.fr

Received July 22, 2008; accepted April 27, 2009.

Background— The management of patients with asymptomatic severe aortic stenosis remains controversial. We sought to develop a continuous risk score for predicting the midterm development of symptoms or adverse events in this setting.

Methods and Results— We prospectively followed 107 patients with asymptomatic aortic stenosis (aged 72 years [63 to 77]; 35 women; aortic-jet velocity, 4.1 m/s [3.5 to 4.4]) at a single center in France. Predefined end points for assessing outcome were the occurrence within 24 months of death or aortic valve replacement necessitated by symptoms or by a positive exercise test. Variables independently associated with outcome were used to build a score that was validated in an independent cohort of 107 patients from Belgium. Independent predictors of outcome were female sex, peak aortic-jet velocity, and B-type natriuretic peptide at baseline. Accordingly, the score could be calculated as follows: Score=[peak velocity (m/s)x2]+(natural logarithm of B-type natriuretic peptidex1.5)+1.5 (if female sex). Event-free survival after 20 months was 80% for patients within the first score quartile compared with only 7% for the fourth quartile. Areas under the receiver operating characteristic curve for the score were 0.90 and 0.89 in the development and validation cohorts, respectively.

Conclusions— If further validation is achieved, this score may be useful to predict outcome in individual patients with asymptomatic aortic stenosis to select those who might benefit from early surgery.

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CLINICAL PERSPECTIVE

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