In:
European Heart Journal - Cardiovascular Imaging, Oxford University Press (OUP), Vol. 22, No. 10 ( 2021-09-20), p. 1142-1148
Abstract:
Severe aortic valve stenosis (AS) is defined by an aortic valve area (AVA) & lt;1 cm2 or an AVA indexed to body surface area (BSA) & lt;0.6 cm/m2, despite little evidence supporting the latter approach and important intrinsic limitations of BSA indexation. We hypothesized that AVA indexed to height (H) might be more applicable to a wide range of populations and body morphologies and might provide a better predictive accuracy. Methods and results In 1298 patients with degenerative AS and preserved ejection fraction from three different countries and continents (derivation cohort), we aimed to establish an AVA/H threshold that would be equivalent to 1.0 cm2 for defining severe AS. In a distinct prospective validation cohort of 395 patients, we compared the predictive accuracy of AVA/BSA and AVA/H. Correlations between AVA and AVA/BSA or AVA/H were excellent (all R2 & gt; 0.79) but greater with AVA/H. Regressions lines were markedly different in obese and non-obese patients with AVA/BSA (P & lt; 0.0001) but almost identical with AVA/H (P = 0.16). AVA/BSA values that corresponded to an AVA of 1.0 cm2 were markedly different in obese and non-obese patients (0.48 and 0.59 cm2/m2) but not with AVA/H (0.61 cm2/m for both). Agreement for the diagnosis of severe AS (AVA & lt; 1 cm2) was significantly higher with AVA/H than with AVA/BSA (P & lt; 0.05). Similar results were observed across the three countries. An AVA/H cut-off value of 0.6 cm2/m [HR = 8.2(5.6–12.1)] provided the best predictive value for the occurrence of AS-related events [absolute AVA of 1 cm2: HR = 7.3(5.0–10.7); AVA/BSA of 0.6 cm2/m2 HR = 6.7(4.4–10.0)] . Conclusion In a large multinational/multiracial cohort, AVA/H was better correlated with AVA than AVA/BSA and a cut-off value of 0.6 cm2/m provided a better diagnostic and prognostic value than 0.6 cm2/m2. Our results suggest that severe AS should be defined as an AVA & lt; 1 cm2 or an AVA/H & lt; 0.6 cm2/m rather than a BSA-indexed value of 0.6 cm2/m2.
Type of Medium:
Online Resource
ISSN:
2047-2404
,
2047-2412
DOI:
10.1093/ehjci/jeaa295
Language:
English
Publisher:
Oxford University Press (OUP)
Publication Date:
2021
detail.hit.zdb_id:
2042482-6
detail.hit.zdb_id:
2647943-6
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