Incremental prognostic value of multiparametric echocardiographic assessment for severe aortic stenosis

A study of hundred forty-nine aortic stenosis patients (74.5±9.4 years, 52% males), with at least one of the following 4 criteria: peak aortic flow velocity (Vmax) >4m/sec; mean transvalvular gradient (MG)>40 mm Hg; aortic valve area (AVA) <1 cm2; AVA indexed for body surface area (AVAI) <0.6 cm2/m2. Mean follow-up duration was 25.9±22.3 months. Outcome was better in the 69 patients (46%) with ≤2 criteria, in the 80 patients with ≥3 criteria (p<0.001); and in patients with neither MG>40 mm Hg nor Vmax >4 m/sec compared with those having at least one of these 2 criteria (p<0.001). At univariate Cox survival analysis, MG>40 mmHg and/or Vmax >4m/sec were the best predictors for the combined end-point. At multivariate analysis, predictors of outcome were male gender (HR 1.751 CI 95% 1.111-2.758, p=0.016), higher MG (HR per 10 mmHg increase 2.626, CI95% 1.663-4.146), p<0.001) and active smoking (HR 3.84 CI 95% 1.15-12.8, p=0.028). In patients with MG≤40 mmHg, an AVAI <0.4 cm2/m2 provided further risk stratification (4-year event-free survival 33%, vs. 58% in patients >0.4 cm2/m2 (p=0.001).