Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Feb 2019)

Prognostic Impact of Aortic Valve Area in Conservatively Managed Patients With Asymptomatic Severe Aortic Stenosis With Preserved Ejection Fraction

  • Norio Kanamori,
  • Tomohiko Taniguchi,
  • Takeshi Morimoto,
  • Hirotoshi Watanabe,
  • Hiroki Shiomi,
  • Kenji Ando,
  • Koichiro Murata,
  • Takeshi Kitai,
  • Yuichi Kawase,
  • Chisato Izumi,
  • Makoto Miyake,
  • Hirokazu Mitsuoka,
  • Masashi Kato,
  • Yutaka Hirano,
  • Shintaro Matsuda,
  • Kazuya Nagao,
  • Tsukasa Inada,
  • Hiroshi Mabuchi,
  • Yasuyo Takeuchi,
  • Keiichiro Yamane,
  • Mamoru Toyofuku,
  • Mitsuru Ishii,
  • Eri Minamino‐Muta,
  • Takao Kato,
  • Moriaki Inoko,
  • Tomoyuki Ikeda,
  • Akihiro Komasa,
  • Katsuhisa Ishii,
  • Kozo Hotta,
  • Nobuya Higashitani,
  • Yoshihiro Kato,
  • Yasutaka Inuzuka,
  • Chiyo Maeda,
  • Toshikazu Jinnai,
  • Yuko Morikami,
  • Naritatsu Saito,
  • Kenji Minatoya,
  • Takeshi Aoyama,
  • Takeshi Kimura

DOI
https://doi.org/10.1161/JAHA.118.010198
Journal volume & issue
Vol. 8, no. 3

Abstract

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Background Data are scarce on the role of aortic valve area (AVA) to identify those patients with asymptomatic severe aortic stenosis (AS) who are at high risk of adverse events. We sought to explore the prognostic impact of AVA in asymptomatic patients with severe AS in a large observational database. Methods and Results Among 3815 consecutive patients with severe AS enrolled in the CURRENT AS (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis) registry, the present study included 1309 conservatively managed asymptomatic patients with left ventricular ejection fraction ≥50%. The study patients were subdivided into 3 groups based on AVA (group 1: AVA >0.80 cm2, N=645; group 2: 0.8 cm2 ≥AVA >0.6 cm2, N=465; and group 3: AVA ≤0.6 cm2, N=199). The prevalence of very severe AS patients (peak aortic jet velocity ≥5 m/s or mean aortic pressure gradient ≥60 mm Hg) was 2.0%, 5.8%, and 26.1% in groups 1, 2, and 3, respectively. The cumulative 5‐year incidence of AVR was not different across the 3 groups (39.7%, 43.7%, and 39.9%; P=0.43). The cumulative 5‐year incidence of the primary outcome measure (a composite of aortic valve–related death or heart failure hospitalization) was incrementally higher with decreasing AVA (24.1%, 29.1%, and 48.1%; P<0.001). After adjusting for confounders, the excess risk of group 3 and group 2 relative to group 1 for the primary outcome measure remained significant (hazard ratio, 2.21, 95% CI, 1.56–3.11, P<0.001; and hazard ratio, 1.34, 95% CI, 1.01–1.78, P=0.04, respectively). Conclusions AVA ≤0.6 cm2 would be a useful marker to identify those high‐risk patients with asymptomatic severe AS, who might benefit from early AVR. Clinical Trial Registration URL: www.umin.ac.jp. Unique identifier: UMIN000012140.

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