Risk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay.

OBJECTIVE

We sought to evaluate prognostic markers of clinical outcome in asymptomatic patients with moderate to severe aortic stenosis (AS).

DESIGN

Prospective follow-up of asymptomatic patients with moderate to severe AS. The patients underwent clinical and Doppler echocardiographic evaluation.

SETTING

Department of Cardiology.

PATIENTS

163 patients with moderate to severe AS (aortic valve area < or =0.6 cm(2)/m(2)).

MAIN OUTCOME MEASURES

Risk stratification. Predefined endpoints for assessing the outcome were the occurrence during follow-up of symptoms, aortic valve replacement or death.

RESULTS

During follow-up (mean, 20 (19) months), 11 patients developed symptoms but were not operated on, 57 required aortic valve replacement and six patients died. In multivariable Cox regression analysis, four parameters that were associated with the outcome were identified: peak aortic jet velocity, left ventricular systolic (LV) longitudinal deformation, valvulo-arterial impedance and indexed left atrial area. Using receiver-operator characteristic curve analysis, a peak aortic jet velocity > or =4.4 m/s, a LV longitudinal myocardial deformation < or =15.9%, a valvular-arterial impedance > or =4.9 mm Hg/ml per m(2) and an indexed left atrial area > or =12.2 cm(2)/m(2) were identified as the best cut-off values to be associated with events.

CONCLUSIONS

In asymptomatic patients with moderate to severe AS, measurements that integrate the ventricular, vascular and valvular components of the disease improve risk stratification.