Valvular heart diseasePrognostic Effect of Long-Axis Left Ventricular Dysfunction and B-Type Natriuretic Peptide Levels in Asymptomatic Aortic Stenosis
Section snippets
Methods
Asymptomatic patients with severe AS were prospectively screened from our echocardiographic laboratory for inclusion in the present study. All the patients met the following criteria: (1) moderate to severe AS, as defined by an aortic valve area of ≤1.2 cm2; (2) no symptoms according to a careful history taken by the referring physician; (3) normal LV ejection fraction (≥55%), as calculated by 2-dimensional echocardiography; (4) no more than mild associated cardiac valve lesions; (5) sinus
Results
The mean patient age was 67 ± 10 years (range 41 to 84). From the patient history and echocardiographic analysis findings, the suspected origin of AS was calcification of a trileaflet (n = 104), bicuspid (n = 15), rheumatic disease (commissural fusion and calcification most prominent along the edges of the cusps on echocardiography; n = 5), and undetermined (n = 2). The aortic valve area range was 0.38 to 1.2 cm2 (mean 0.82 ± 0.15), and the peak aortic pressure gradient was 77 ± 21 mm Hg. The
Discussion
The decision to perform surgery on asymptomatic patients with AS remains controversial.3, 4 The immediate risks of surgery are often weighed against the later risk of events without intervention.15 Therefore, reliable risk stratification is clinically important.16, 17, 18 In the present prospective study, we report, for the first time, the added prognostic value of tissue Doppler imaging and BNP measurement compared to the classical clinical and echocardiographic parameters in a prospective
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