4.7 Article

Clinical Outcome in Asymptomatic Severe Aortic Stenosis Insights From the New Proposed Aortic Stenosis Grading Classification

Journal

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 59, Issue 3, Pages 235-243

Publisher

ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2011.08.072

Keywords

aortic stenosis; classification; echocardiography; outcome; valve

Funding

  1. Fonds Leon Fredericq, Liege, Belgium

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Objectives This study examined the clinical course of patients with asymptomatic severe aortic stenosis (AS) according to the new proposed aortic valve stenosis grading classification. Background The management of patients with asymptomatic severe AS remains controversial. Moreover, under the same denomination of severe AS, several entities might be identified according to transvalvular flow rates and pressure gradients, resulting in 4 flow-gradient patterns. Methods Transthoracic echocardiography and measurement of B-type natriuretic peptide level from venous blood sample were performed in 150 consecutive patients with asymptomatic severe AS and normal exercise test. Patients were classified in 4 groups, depending on left ventricular flow state (normal flow [NF] vs. low flow [LF]: 35 ml/m(2)) and pressure gradient levels (low gradient [LG] vs. high gradient [HG]: 40 mm Hg). Results Patients with NF/LG had significantly lower B-type natriuretic peptide than those with LF/HG and LF/LG. The mean follow-up was 27 +/- 12 months. At 2 years, cardiac event-free survival was 83 +/- 6%, 44 +/- 6%, 30 +/- 12%, and 27 +/- 13% in NF/LG, NF/HG, LF/HG, and LF/LG groups, respectively (p < 0.0001). On multivariable analysis, LF/LG (hazard ratio [HR]: 5.26, 95% confidence interval [CI]: 2.04 to 14.3, p = 0.045) and LF/HG (HR: 2.38, 95% CI: 1.02 to 5.55, p = 0.001) were identified as strong independent determinants of poor prognosis as compared with NF/HG. By limiting the multivariable analysis to patients with LF, LF/LG was an independent predictor of markedly reduced cardiac event-free survival when compared with LF/HG (HR: 5.4, 95% CI: 1.03 to 28.6, p = 0.046). Conclusions The use of the new proposed AS grading classification integrating valve area and flow-gradient patterns allows a better characterization of the clinical outcome of patients with asymptomatic severe AS. (J Am Coll Cardiol 2012;59:235-43) (C) 2012 by the American College of Cardiology Foundation

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