Abstract 10171: Aortic Valve Area Index, but Not Aortic Valve Area, Strongly Predicts the Outcome of Patients with Severe Aortic Stenosis
Background The management of asymptomatic patients with severe AS remains controversial.Although aortic valve area (AVA) is recommended as a marker of AS severity, AVA is not necessarily related to mortality.Recently, ACC/AHA Guideline proposes that aortic valve area index (AVAI) < 0.6 cm2/m2 is an indicator of severe AS. However a prognostic value of AVAI in patients with severe AS is not elucidated, therefore the purpose of this study was to clarify the clinical value of AVAI for risk stratification beyond the conventional definitions of AS.
Methods We enrolled 129 patients (mean age 73 ± 11 years) who had severe AS defined by an AVA< 1.0 cm2 with echocardiography and followed adverse events (cardiac death, sudden death, AVR) after the initial examinations.
Results The median follow-up was 38 ± 27 months. During follow up, 69 events occurred (20 cardiac death, 10 sudden death, and 39 AVR). On the multivariate analysis, only AVAI < 0.6 cm2/m2, but not the conventional definitions of AS, is independently associated with adverse events (hazard ratio 0.054, 95%C.I. 0.004-0.75, p=0.02). In addition, the patients were classified into 4 groups according to AVAI, symptoms, and peak aortic jet velocity (PAJV) (Figure). Event-free survival rate of asymptomatic patients with AVAI ≥ 0.6cm2/m2 and PAJV ≤ 4m/s was significantly better than that of other 3 groups (P < 0.01, v.s. other 3 groups)(Figure), whereas patients with AVAI < 0.6cm2/m2 represented poor prognosis, even without symptom and with PAJV ≤ 4m/s.
Conclusions AVAI provides better prognostic information compared to the conventional definitions of AS. Early elective AVR might be avoidable in asymptomatic patients with AVAI ≥0.6 cm2/m2 and peak aortic jet velocity ≤ 4m/s, even AVA < 1.0 cm2, considering risks of surgery and potential long-term complications related to the prosthetic valve.
- © 2011 by American Heart Association, Inc.