RT Journal Article
SR Electronic
T1 Discordant severity criteria in patients with moderate aortic stenosis: prognostic implications
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e001639
DO 10.1136/openhrt-2021-001639
VO 8
IS 1
A1 Stephan M Pio
A1 Mohammed R Amanullah
A1 Steele C Butcher
A1 Kenny Y Sin
A1 Nina Ajmone Marsan
A1 Philippe Pibarot
A1 Nicolas M Van Mieghem
A1 Zee Pin Ding
A1 Philippe Généreux
A1 Martin B Leon
A1 See Hooi Ewe
A1 Victoria Delgado
A1 Jeroen J Bax
YR 2021
UL http://openheart.bmj.com/content/8/1/e001639.abstract
AB Background The criteria to define the grade of aortic stenosis (AS)—aortic valve area (AVA) and mean gradient (MG) or peak jet velocity—do not always coincide into one grade. Although in severe AS, this discrepancy is well characterised, in moderate AS, the phenomenon of discordant grading has not been investigated and its prognostic implications are unknown.Objectives To investigate the occurrence of discordant grading in patients with moderate AS (defined by an AVA between 1.0 cm² and 1.5 cm² but with an MG <20 mm Hg) and how these patients compare with those with concordant grading moderate AS (AVA between 1.0 cm² and 1.5 cm² and MG ≥20 mm Hg) in terms of clinical outcomes.Methods From an ongoing registry of patients with AS, patients with moderate AS based on AVA were selected and classified into discordant or concordant grading (MG <20 mm Hg or ≥20 mm Hg, respectively). The clinical endpoint was all-cause mortality.Results Of 790 patients with moderate AS, 150 (19.0%) had discordant grading, moderate AS. Patients with discordant grading were older, had higher prevalence of previous myocardial infarction and left ventricular (LV) hypertrophy, larger LV end-diastolic and end-systolic volume index, higher LV filling pressure and lower LV ejection fraction and stroke volume index as compared with their counterparts. After a median follow-up of 4.9 years (IQR 3.0–8.2), patients with discordant grading had lower aortic valve replacement rates (26.7% vs 44.1%, p<0.001) and higher mortality rates (60.0% vs 43.1%, p<0.001) as compared with patients with concordant grading. Discordant grading moderate AS, combined with low LV ejection fraction, presented the higher risk of mortality (HR 2.78 (2.00–3.87), p<0.001).Conclusion Discordant-grading moderate AS is not uncommon and, when combined with low LV ejection fraction, is associated with high risk of mortality.The data presented in the current manuscript are available upon reasonable request. The data are not in a repository and consist of deidentified participant data which can be available upon reasonable request at https://orcid.org/0000-0002-9841-2737.