Abstract 12862: Energy Loss Index as Prognosticator in Inconsistently Graded Asymptomatic Aortic Stenosis

Abstract

Background: We tested pressure recovery adjusted aortic valve area index (ELI) in prediction of outcome in asymptomatic patients with inconsistently graded AS (mean gradient ≤40 mmHg and aortic valve area <1.0 cm²).This is a pre-specified analysis.

Methods and Results: The relation between ELI and rate of aortic valve events (AVE) was assessed by Receiver Operating Characteristic (ROC) analysis and Cox regression in 1563 patients with initial asymptomatic AS in the Simvastatin and Ezetimibe in Aortic Stenosis study. Inconsistently graded AS was present in 28.3% patients at baseline, and 48.6% of these patients experienced an AVE during 4.3 years of follow-up. In multivariate Cox regression, lower ELI predicted a 3-fold higher rate of AVE independent of conventional measures of AS (Table). However, when hazards from the final Cox regression model with and without ELI among the covariates were compared in ROC analysis , adding ELI to the model did not significantly increase the AUC (0.69 vs. 0.67, p= 0.579).

Conclusion: In asymptomatic patients with inconsistently graded severe AS, ELI predicted rates of AVE independent of but not superior to conventional measures of AS severity. Table. Baseline ELI as predictor of AVE in patients with inconsistently graded severe AS. Multivariate Cox regression analyses. Variable included in all models: study treatment. na, not included in model *p<0.001, †p<0.05