Abstract 9272: Energy Loss Index as Predictor Of Aortic Valve Events in Asymptomatic Aortic Stenosis Patients — (a Seas Substudy)
Background: Aortic valve area index (AVAI) is routinely used for assessment of aortic stenosis (AS) severity. Pressure recovery adjusted AVAI [energy loss index (ELI)] has been suggested as a superior measure of AS severity. However, its prognostic value has not been assessed in a large, prospective study of initial asymptomatic AS patients.
Methods: Cox regression and receiver operating curve (ROC) analysis were used to assess the relation between baseline ELI and rate of aortic valve events (AVE) in 1563 patients with asymptomatic AS (mean age 67±10 years, 39% women) receiving randomized placebo controlled combined simvastatin-ezetimibe treatment in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. AVE was a prespecified secondary end—point (combined cardiovascular death, aortic valve replacement and hospitalisation for heart failure due to AS progression). Severe AS was identified as ELI and AVAI <0.6 cm2/m2, respectively.
Results: A total of 498 AVE occurred during 4.3 years of treatment. Severe AS by ELI was present in 374 patients. In univariate Cox regression analyses, lower baseline ELI (HR=5.3, CI=3.9–7.4) and AVAI (HR=17.0, CI=10.3–27.8) both predicted higher rates of AVE (p<0.001). In ROC analysis, the area under the curve (AUC) was similar for ELI and AVAI (both AUC=0.32, p<0.001). In multivariate Cox regression analysis, lower ELI predicted higher rate of AVE independent of having severe AS by AVAI (Table).
Conclusion: In initial asymptomatic AS patients both AVAI and ELI predict rates of AVE. However, independent of having severe AS by AVAI, ELI gives additional prognostic information.
- © 2010 by American Heart Association, Inc.