Abstract 13381: The Association of Aortic Valve Weight With Echocardiographic Indices of Aortic Stenosis Severity in 610 Patients With Normal Left Ventricular Ejection Fraction Undergoing Surgical Aortic Valve Replacement for Severe Isolated Aortic Stenosis
Background: The magnitude of aortic valve calcification (AVC) is associated with aortic stenosis (AS) severity. AV weight (AVW)is an accurate measure of valvular calcium load, and reportedly, correlates more closely with transvalvular pressure gradients than with AV area (AVA). Hypothesis: Due to multiple assumptions made when measuring or calculating the echocardiographic (echo) variables used for determination of AS severity, their association with AVW is only modest.
Methods: Between 2010-14, 610 consecutive patients (pts) undergoing surgical AV replacement (AVR) for severe isolated AS,(age 76.4 ± 9.3 yrs, 58% men, AVA index 0.36 ± 0.09 cm2 /m2, EF = 61.0 ± 5.0 %), had AVs weighed (mean AVW = 2.5 ± 1.1 g, median = 2 gs, range: 1-11 g), and preoperative echo studies. Pearson correlation was used to measure the linear association between AVW and the echo variables, and a number of covariates (specified in the table) were included through the calculation of partial correlation.
Results: Women have a lower AVW than men by 0.6 g (24%) (p<0.0001) when normalized for BSA (p<0.0001) or AVA index (p<0.0001) but not when corrected for aortic annular area. Compared with pts with low gradients, those pts with MG ≥ 40 mm Hg had 0.4 g (17%) higher AVW (p<0.0001) whereas no difference were found between those with normal vs low stroke volume index. Bicuspid AV are heavier than tricuspid valves (3.3 ± 2 gr vs. 2.4 ± 0.9 g, p = 0.001) even when adjusted for BSA, AVA and annular area. The correlations of AVW with echo variables are shown below. Conclusions: 1. In severe isolated AS with normal EF, AVW is modestly associated with pressure gradients, and not with LV stroke work loss. 2. Women have lower AVW than men due to smaller aortic annulus, and those with MG≥40 have higher AVW than those with MG<40 as those with bicuspid vs, tricuspid AVs. 3. These findings should be considered when interpreting the non-invasive studies evaluating AV calcium load in challenging cases of severe AS.
Author Disclosures: D. Alexandru: None. F. Petillo: None. S. Pollack: None. N. Reichek: None. E. Barasch: None.
- © 2015 by American Heart Association, Inc.