Prognostic Impact of Peak Aortic Jet Velocity in Conservatively Managed Patients With Severe Aortic Stenosis: An Observation From the CURRENT AS Registry
Authors: Nakatsuma Kenji , Taniguchi Tomohiko , Morimoto Takeshi , Shiomi Hiroki , Ando Kenji , Kanamori Norio , Murata Koichiro , Kitai Takeshi , Kawase Yuichi , Izumi Chisato , Miyake Makoto , Mitsuoka Hirokazu , Kato Masashi , Hirano Yutaka , Matsuda Shintaro , Inada Tsukasa , Nagao Kazuya , Murakami Tomoyuki , Takeuchi Yasuyo , Yamane Keiichiro , Toyofuku Mamoru , Ishii Mitsuru , Minamino‐Muta Eri , Kato Takao , Inoko Moriaki , Ikeda Tomoyuki , Komasa Akihiro , Ishii Katsuhisa , Hotta Kozo , Higashitani Nobuya , Kato Yoshihiro , Inuzuka Yasutaka , Maeda Chiyo , Jinnai Toshikazu , Morikami Yuko , Saito Naritatsu , Minatoya Kenji , Kimura Takeshi , Imai Masao , Tazaki Junichi , Toyota Toshiaki , Higami Hirooki , Kawaji Tetsuma , Shirai Shinichi , Korai Kengo , Arita Takeshi , Miura Shiro , Yamaji Kyohei , Kim Kitae , Iwasaki Keiichiro , Miyawaki Hiroshi , Misao Ayumi , Kuwayama Akimune , Ohya Masanobu , Shimada Takenobu , Amano Hidewo , Amano Masashi , Takahashi Yusuke , Yoshikawa Yusuke , Nishimura Shunsuke , Kuroda Maiko , Mizoguchi Tetsu , Yokomatsu Takafumi , Kushiyama Akihiro , Yaku Hidenori , Watanabe Toshimitsu , Sugioka Sachiko , Takahashi Naoki , Fukuchi Kohei , Mabuchi Hiroshi , Takeda Teruki , Sakaguchi Tomoko , Yamaji Masayuki , Maenaka Motoyoshi , Tadano Yutaka , Motooka Makoto , Nishikawa Ryusuke , Kawato Mitsunori , Kinoshita Minako , Aida Kenji , Takahashi Kousuke , Ko Euihong , Masunaga Nobutoyo , Ogawa Hisashi , Iguchi Moritake , Unoki Takashi , Takabayashi Kensuke , Hamatani Yasuhiro , Yamashita Yugo , Tsuji Shuhei , Nishio Soji , Seki Jyunya , Yamada Miho , Kawamoto Akira , Sogabe Kouji , Tachiiri Michiya , Matsumura Yukiko , Ota Chihiro , Sakata Ryuzo , Minakata Kenji , Hanyu Michiya , Yamazaki Fumio , Koyama Tadaaki , Komiya Tatsuhiko , Yamanaka Kazuo , Nishiwaki Noboru , Ohnaka Motoaki , Osada Hiroaki , Meshii Katsuaki , Saga Toshihiko , Kitayama Hitoshi , Nakayama Shogo , Sakaguchi Genichi , Iwakura Atsushi , Shiraga Kotaro , Ueyama Koji , Fujiwara Keiichi , Fukumoto Atsushi , Miwa Senri , Nishizawa Junichiro , Kitano Mitsuru , Watanabe Hirotoshi , Sasa Tomoki 
Published: July 2017

Background

There are limited data regarding the risk stratification based on peak aortic jet velocity (Vmax) in patients with severe aortic stenosis (
AS
).

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 study population consisted of 1075 conservatively managed patients with Vmax ≥4.0 m/s and left ventricular ejection fraction ≥50%. The study patients were subdivided into 3 groups based on Vmax (group 1, 4.0 ≤ Vmax <4.5 m/s, N=550; group 2, 4.5 ≤ Vmax <5 m/s, N=279; and group 3, Vmax ≥5 m/s, N=246). Cumulative 5‐year incidence of
AS
‐related events (aortic valve–related death or heart failure hospitalization) was incrementally higher with increasing Vmax (entire population; 38.0%, 49.4%, and 62.8%,
P
<0.001; symptomatic patients; 55.7%, 60.9%, and 72.2%,
P
=0.008; and asymptomatic patients; 29.4%, 38.9%, and 47.7%,
P
=0.005). After adjusting for confounders, the excess risk of group 2 and group 3 relative to group 1 for
AS
‐related events remained significant (hazard ratio, 1.39; 95%
CI
, 1.07–1.81;
P
=0.02, and hazard ratio, 1.53; 95%
CI
, 1.17–2.00;
P
=0.002, respectively). The effect size of group 3 relative to group 1 for
AS
‐related events in asymptomatic patients (N=479) was similar to that in symptomatic patients (N=596; hazard ratio, 1.59; 95%
CI
, 1.01–2.52;
P
=0.047, and hazard ratio, 1.67; 95%
CI
, 1.16–2.40,
P
=0.008, respectively), and there was no significant overall interaction between the symptomatic status and the effect of the Vmax categories on
AS
‐related events (interaction,
P
=0.88).

Conclusions

In conservatively managed severe
AS
patients with preserved left ventricular ejection fraction, increasing Vmax was associated with incrementally higher risk for
AS
‐related events. However, the cumulative 5‐year incidence of the
AS
‐related events remained very high even in asymptomatic patients with less greater Vmax.