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. 2016 May 3;5(5):e003146.
doi: 10.1161/JAHA.115.003146.

Prognostic Value of Aortic Valve Area by Doppler Echocardiography in Patients With Severe Asymptomatic Aortic Stenosis

Sylvestre Maréchaux  1 , Anne Ringle  2 , Dan Rusinaru  3 , Nicolas Debry  2 , Yoan Bohbot  3 , Christophe Tribouilloy  4
Affiliations

Prognostic Value of Aortic Valve Area by Doppler Echocardiography in Patients With Severe Asymptomatic Aortic Stenosis

Sylvestre Maréchaux et al. J Am Heart Assoc. .

Abstract

Background: The aim of this study was to evaluate the relationship between aortic valve area (AVA) obtained by Doppler echocardiography and outcome in patients with severe asymptomatic aortic stenosis and to define a specific threshold of AVA for identifying asymptomatic patients at very high risk based on their clinical outcome.

Methods and results: We included 199 patients with asymptomatic severe aortic stenosis (AVA ≤1.0 cm(2)). The risk of events (death or need for aortic valve replacement) increased linearly on the scale of log hazard with decreased AVA (adjusted hazard ratio 1.17; 95% CI 1.06-1.29 per 0.1 cm(2) AVA decrement; P=0.002). Event-free survival at 12, 24, and 48 months was 63±6%, 51±6%, and 34±6%, respectively, for AVA 0.8 to 1 cm(2); 49±6%, 36±6%, and 26±6%, respectively, for AVA 0.6 to 0.8 cm(2); and 33±8%, 20±7%, and 11±5%, respectively, for AVA ≤0.6 cm(2) (Ptrend=0.002). Patients with AVA ≤0.6 cm(2) had a significantly increased risk of events compared with patients with AVA 0.8 to 1 cm(2) (adjusted hazard ratio 2.22; 95% CI 1.41-3.52; P=0.001), whereas patients with AVA 0.6 to 0.8 cm(2) had an increased risk of events compared with those with AVA 0.8 to 1 cm(2), but the difference was not statistically significant (adjusted hazard ratio 1.38; 95% CI 0.93-2.05; P=0.11). After adjustment for covariates and aortic valve replacement as a time-dependent variable, patients with AVA ≤0.6 cm(2) had a significantly greater risk of all-cause mortality than patients with AVA >0.6 cm(2) (hazard ratio 3.39; 95% CI 1.80-6.40; P<0.0001).

Conclusions: Patients with severe asymptomatic aortic stenosis and AVA ≤0.6 cm(2) displayed an important increase in the risk of adverse events during short-term follow-up. Further studies are needed to determine whether elective aortic valve replacement improves outcome in this high-risk subgroup of patients.

Keywords: Doppler echocardiography; aortic stenosis; outcome; surgery.

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Figures

Figure 1
Figure 1
Kaplan–Meier event‐free survival curves according to AVA categories. AVA indicates aortic valve area; AVR, aortic valve replacement.
Figure 2
Figure 2
Adjusted curves of event‐free survival according to AVA categories. Curves are adjusted for age, sex, comorbidity index, coronary artery disease, hypertension, atrial fibrillation, and ejection fraction. AVA indicates aortic valve area; AVR, aortic valve replacement.
Figure 3
Figure 3
Kaplan–Meier curves of cumulative mortality according to AVA ≤0.6 and >0.6 cm2. AVA indicates aortic valve area.
Figure 4
Figure 4
Cumulative hazard of death according to AVA ≤0.6 and >0.6 cm2. Curves are adjusted for age, sex, comorbidity index, coronary artery disease, hypertension, atrial fibrillation, left ventricular ejection fraction and aortic valve replacement as a time‐dependent variable. AVA indicates aortic valve area.
Figure 5
Figure 5
A, Adjusted curves of event‐free survival according to AVA categories with patients with mild to moderate AS as the referent group. B, Cumulative hazard of death according to AVA ≤0.6, 0.6–0.8, and 0.8–1 cm2, with patients with mild to moderate AS as the referent group. Curves are adjusted for age, sex, comorbidity index, coronary artery disease, hypertension, atrial fibrillation, and left ventricular ejection fraction. AS indicates aortic stenosis; AVA, aortic valve area; AVR, aortic valve replacement.
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