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Vol. 56. Issue 4.
Pages 267-275 (October - December 2021)
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Vol. 56. Issue 4.
Pages 267-275 (October - December 2021)
Original article
Clinical outcome in significant aortic stenosis with preserved systolic function according to aortic valve area and stroke volume
Pronóstico de la estenosis aórtica grave con función sistólica conservada en función del área valvular aórtica y el volumen eyectivo
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Laura Galian-Gaya,b,
Corresponding author
lauragaliangay@gmail.com

Corresponding author.
, Guillem Casasa,b, Teresa González-Alujasa,b, Augusto Sao Avilésa,b, Gisela Teixidó-Turàa,b, Laura Gutiérreza,b, José F. Rodríguez-Palomaresa,b, Chiara Granatoa,b, Rubén Fernández-Galeraa,b, Filipa Valentea,b, Andrea Gualaa,b, Aroa Ruiza,b, Artur Evangelistaa,b
a Servicio de Cardiología, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, CIBER-CV, Spain
b Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Figures (2)
Tables (5)
Table 1. Baseline demographic, clinical and echocardiographic parameters according to aortic valve area group.
Table 2. Baseline echocardiographic parameters and symptomatic status according to index aortic valve area group.
Table 3. Echocardiographic parameters according to the symptomatic status.
Table 4. Rates of mortality and/or AVR, mortality alone and AVR alone in the different AVA groups.
Table 5. Rates of mortality and/or AVR, mortality alone and AVR alone in the different AVAi groups.
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Additional material (1)
Abstract
Introduction and objectives

Current 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.

Methods

A 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.

Results

After 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.

Conclusions

Patients 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.

Keywords:
Aortic stenosis
Paradoxical low-flow low-gradient
Echocardiography
Aortic valve surgery
Heart valve disease
Resumen
Introducción y objetivos

Las guías actuales de práctica clínica establecen el punto de corte del área valvular aórtica (AVA) en <1cm2 para la estenosis aórtica (EAo) grave; sin embargo, varios estudios sugieren que un punto de corte con un umbral más bajo clasificaría mejor a los pacientes en riesgo. El objetivo de este estudio fue evaluar la evolución de los pacientes con EAo según el AVA.

Métodos

Un total de 140 pacientes con estenosis aórtica moderada-grave y fracción de eyección conservada se clasificaron en 3 grupos en función del AVA basal. Los resultados (intervención sobre la válvula aórtica o mortalidad global) se compararon mediante un análisis de regresión de Cox.

Resultados

Tras un seguimiento de 4,1 años (DE 1,9), se produjo muerte o reemplazo valvular aórtico en 47 (84,1%) pacientes con AVA<0,75cm2, 48 (81,3%) con AVA 0,75-1cm2 y 15 (60%) con AVA>1cm2. La incidencia de la variable combinada fue significativamente mayor en pacientes con AVA<0,75cm2 que AVA 0,75-1cm2 y AVA>1cm2 (4,71, 3,43 y 2,48 eventos por 100 personas/año, respectivamente) (p=0,003). Las diferencias en las curvas de supervivencia provienen del grupo AVA<0,75cm2 (HR=1,58; p=0,028 en comparación con el grupo AVA 0,75-1cm2) sin hallarse diferencias entre los otros 2 grupos (p=0,117). Los resultados según el AVA indexada (AVAi) fueron equiparables con los resultados previamente mencionados.

Conclusiones

Los pacientes con EAo y AVA entre 0,75 y 1cm2 mostraron una evolución similar a aquellos con AVA>1cm2. Sin embargo, aquellos con AVA<0,75cm2 mostraron un mayor riesgo de complicaciones. Un valor de AVA<0,75cm2 distinguiría mejor a los pacientes en riesgo que podrían beneficiarse de un enfoque más agresivo.

Palabras clave:
Estenosis aórtica
Bajo-flujo bajo-gradiente paradójico
Ecocardiografía
Cirugía valvular aórtica
Enfermedad valvular

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