Clinical outcome in significant aortic stenosis with preserved systolic function according to aortic valve area and stroke volume

Abstract

Introduction and objectivesCurrent guidelines establish an aortic valve area (AVA) cut-off point of <1cm2 for severe aortic stenosis; however, several studies suggest that a lower threshold area would better classify patients at risk. The aim of this study was to evaluate the outcome of patients with AS according to AVA. MethodsA total of 140 patients with moderate-severe aortic stenosis and preserved ejection fraction were classified in three different groups according to baseline AVA. The outcomes (aortic valve intervention or all-cause mortality) were compared using Cox regression analysis. ResultsAfter follow-up of 4.1 years (SD 1.9), death and/or aortic valve replacement occurred in 47 (84.1%) patients with AVA<0.75cm2, 48 (81.3%) with AVA 0.75–1cm2 and 15 (60%) with AVA>1cm2. Incidence of the combined endpoint was significantly higher in patients with AVA<0.75cm2 than AVA 0.75–1cm2 and AVA>1cm2 (4.71, 3.43 and 2.48 events per 100 person-years respectively) (P=.003). Survival differences stemmed only from the AVA <0.75cm2 group (HR, 1.58; P=.028 compared to the AVA 0.75–1cm2 group) with no differences between the 2 other groups (P=.117). Outcomes according to the indexed AVA (AVAi) were in accordance with the aforementioned results. ConclusionsPatients with aortic stenosis and AVA between 0.75 and 1cm2 showed similar evolution to those with AVA>1cm2. However, those with AVA<0.75cm2 had a higher risk of complicated events. An AVA value <0.75cm2 would better distinguish patients at risk who might benefit from a more aggressive approach.