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. 2022 Jul 28;11(15):4386.
doi: 10.3390/jcm11154386.

Screening Tool to Identify Patients with Advanced Aortic Valve Stenosis

Sameh Yousef  1 , Andrea Amabile  1 , Chirag Ram  1 , Huang Huang  2 , Varun Korutla  1 , Saket Singh  1 , Ritu Agarwal  3 , Roland Assi  1 , Rita K Milewski  1 , Yawei Zhang  2 , Prakash A Patel  4 , Markus Krane  1 , Arnar Geirsson  1 , Prashanth Vallabhajosyula  1
Affiliations

Screening Tool to Identify Patients with Advanced Aortic Valve Stenosis

Sameh Yousef et al. J Clin Med. .

Abstract

(1) Background: The clinical burden of aortic stenosis (AS) remains high in Western countries. Yet, there are no screening algorithms for this condition. We developed a risk prediction model to guide targeted screening for patients with AS. (2) Methods: We performed a cross-sectional analysis of all echocardiographic studies performed between 2013 and 2018 at a tertiary academic care center. We included reports of unique patients aged from 40 to 95 years. A logistic regression model was fitted for the risk of moderate and severe AS, with readily available demographics and comorbidity variables. Model performance was assessed by the C-index, and its calibration was judged by a calibration plot. (3) Results: Among the 38,788 reports yielded by inclusion criteria, there were 4200 (10.8%) patients with ≥moderate AS. The multivariable model demonstrated multiple variables to be associated with AS, including age, male gender, Caucasian race, Body Mass Index ≥ 30, and cardiovascular comorbidities and medications. C-statistics of the model was 0.77 and was well calibrated according to the calibration plot. An integer point system was developed to calculate the predicted risk of ≥moderate AS, which ranged from 0.0002 to 0.7711. The lower 20% of risk was approximately 0.15 (corresponds to a score of 252), while the upper 20% of risk was about 0.60 (corresponds to a score of 332 points). (4) Conclusions: We developed a risk prediction model to predict patients' risk of having ≥moderate AS based on demographic and clinical variables from a large population cohort. This tool may guide targeted screening for patients with advanced AS in the general population.

Keywords: aortic; mortality; prediction; risk; stenosis.

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Conflict of interest statement

Geirsson receives a consulting fee for being a member of the Medtronic Strategic Surgical Advisory Board. Medtronic produces valve products for valve replacement and repairs. Krane is a physician proctor and a member of the medical advisory board for JOMDD, a physician proctor for Peter Duschek, and has received speakers’ honoraria from Medtronic and Terumo. The remaining authors have nothing to disclose.

Figures

Figure 1
Figure 1
Analytic cohort building. Consort diagram describing the inclusion and exclusion steps that led to the final analytic cohort.
Figure 2
Figure 2
Discrimination ability of the model (to classify patients into moderate/severe AS versus no AS).
Figure 3
Figure 3
Calibration of the model.
See this image and copyright information in PMC

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