Author + information
- Praveen Mehrotra,
- Katrijn Jansen,
- Timothy Tan,
- Aidan Flynn,
- Sammy Elmariah,
- Michael Picard and
- Judy Hung
Current guidelines define severe aortic stenosis (AS) as an aortic valve area (AVA) <1.0 cm2. However, it is uncertain if all of these patients have the same prognosis. We hypothesized that AS patients with an AVA 0.8–0.99 cm2would have a more favorable prognosis than those with an AVA <0.8 cm2.
Patients with isolated, severe AS and ejection fraction >55% were examined over a 1 year period. Patients with an AVA <0.8 cm2(n=155) were compared to those with an AVA 0.8–0.99 cm2(n=105) and 1.0–1.3 cm2(n=70). Patients with an AVA 0.8–0.99 cm2were considered high risk if they had a high mean gradient (>40 mmHg) or a low stroke volume index (<35 mL/m2) regardless of gradient. The endpoint of this study was a combination of death from any cause or valve replacement at 3 years.
The mean gradient (50 vs. 33 vs. 19 mmHg, p<0.001) was highest in patients with an AVA <0.8 cm2. The combined endpoint was achieved in 71% of AS patients with an AVA <0.8 cm2compared to 51% of patients with an AVA 0.8–0.99 cm2and 21% of moderate AS patients (p<0.001). When AS patients with an AVA 0.8–0.99 cm2were divided into high and low risk groups, the high risk group (n=39) had outcomes (69%) similar to those with AVA <0.8 cm2, while low risk patients (n=66) had a better outcome (41%) at 3 years.
Patients with an AVA 0.8–0.99 cm2are classified as severe but their prognosis is better than those with an AVA <0.8 cm2. The outcomes of these patients can be better defined when they are stratified by gradient and/or stroke volume index.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.–10:45 a.m.
Session Title: Valvular Heart Disease: Clinical I – Aortic Stenosis
Abstract Category: 31. Valvular Heart Disease: Clinical
Presentation Number: 1113–87
- 2013 American College of Cardiology Foundation