Prognosis in asymptomatic patients with discordantly graded aortic valve stenosis based on pressure recovery adjusted valve area.

ABSTRACT:

Objective

We hypothesised that patients with asymptomatic aortic stenosis (AS) who remain with discordantly graded aortic valve stenosis (DGAS) after adjustment for pressure recovery in the aortic root represents a subgroup of patients with increased cardiovascular risk.

Methods

Data from 1353 patients with asymptomatic mild-moderate AS and preserved left ventricular ejection fraction enrolled in the Simvastatin and Ezetimibe in AS study was used. DGAS was identified as combined pressure adjusted valve area (energy loss) <1.0 cm² and mean aortic gradient<40 mm Hg (DGAS_EL). Outcome was assessed in Cox regression analysis and reported as HR and 95% CI.

Results

DGAS_EL was found in 196 (14.5%) patients at baseline, and was associated with older age, female sex, smaller aortic annulus diameter, lower heart rate, more extensive valve calcification and low flow (all p<0.05). In Cox regression analysis, DGAS_EL was associated with higher rate of heart failure (HF) hospitalisation (HR 3.31 (95% CI 1.54 to 7.09)), cardiovascular death (HR 2.63 (95% CI 1.34 to 5.17)) and all-cause mortality (HR 1.73 (95% CI 1.04 to 2.87)) independent of confounders including low flow and aortic valve calcification (all p<0.05).

Conclusions

Patients with asymptomatic AS who remain with discordant grading after adjustment for pressure recovery have increased risk for HF and death.

Trial registration number

NCT00092677.

SUBMITTER: Bahlmann E 

PROVIDER: S-EPMC9703352 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature