Prognostic Impact of Aortic Valve Area in Conservatively Managed Patients With Asymptomatic Severe Aortic Stenosis With Preserved Ejection Fraction
Authors: Kanamori Norio , Taniguchi Tomohiko , Morimoto Takeshi , Watanabe Hirotoshi , Shiomi Hiroki , Ando Kenji , Murata Koichiro , Kitai Takeshi , Kawase Yuichi , Izumi Chisato , Miyake Makoto , Mitsuoka Hirokazu , Kato Masashi , Hirano Yutaka , Matsuda Shintaro , Nagao Kazuya , Inada Tsukasa , Mabuchi Hiroshi , 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 , Aoyama Takeshi , Kimura Takeshi , Sakata Ryuzo , 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 , Takeda Teruki , Sakaguchi Tomoko , Maeda Keiko , 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 , Minakata Kenji , Hanyu Michiya , Yamazaki Fumio , Koyama Tadaaki , Komiya Tatsuhiko , Yamanaka Kazuo , Nishiwaki Noboru , Nakajima Hiroyuki , Ohnaka Motoaki , Osada Hiroaki , Meshii Katsuaki , Saga Toshihiko , Onoe Masahiko , Kitayama Hitoshi , Nakayama Shogo , Sakaguchi Genichi , Iwakura Atsushi , Shiraga Kotaro , Ueyama Koji , Fujiwara Keiichi , Fukumoto Atsushi , Miwa Senri , Nishizawa Junichiro , Kitano Mitsuru , Nakatsuma Kenji , Sasa Tomoki 
Published: February 2019

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 cm
2
, N=645; group 2: 0.8 cm
2
≥AVA >0.6 cm
2
, N=465; and group 3: AVA ≤0.6 cm
2
, 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 cm
2
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.