Survival and predictors of outcome in moderate mixed aortic valve disease

Abstract

Abstract Background Coexisting moderate aortic stenosis and regurgitation (MAVD) is common. The haemodynamic effect of MAVD is poorly understood with sparse data to guide risk stratification. Purpose This study aims to compare all-cause mortality in moderate MAVD with matched controls and identify markers associated with prognosis. Methods Patients with both moderate aortic stenosis (aortic valve area [AVA] 1.0-1.5cm2) and regurgitation (vena contracta [VC] 0.3-0.6cm) were identified from a multicentre registry. All-cause mortality was compared to an age and sex matched UK population. The association between echocardiographic and clinical metrics with all-cause mortality was evaluated. Results 207 patients were included, age 78 [66-84] years and moderate MAVD (AVA 1.2 [1.1- 1.4]cm2 and VC 0.4 [0.4-0.5]cm). Over a median follow up of 3.2 years, 75/207 (36.2%) patients died. Patients with moderate MAVD had a significantly higher mortality compared to age and sex matched controls (36% versus 14.3%), p<0.001. Peak aortic jet velocity (Vmax) was the only haemodynamic metric independently associated with mortality [hazard ratio (HR): 0.61, 95% confidence interval (CI): 0.39-0.93; p=0.02] in a multivariate model along with age, creatinine and previous cerebrovascular accident. Compared to patients with Vmax >3m/sec, those with Vmax ≤3.0m/s had lower LVEF and stroke volume and a higher mortality (HR: 1.76, 95% CI: 1.10-2.80; p=0.017). Conclusions Moderate MAVD is associated with reduced survival compared to age and sex matched controls. Patients with discordant low Vmax ≤3 m/sec, have disproportionately worse outcome and may represent a high risk ‘low flow’ phenotype.Figure 1