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Transvalvular Flow Rate Determines Prognostic Value of Aortic Valve Area in Aortic Stenosis.
- Source :
-
Journal of the American College of Cardiology (JACC) . Apr2020, Vol. 75 Issue 15, p1758-1769. 12p. - Publication Year :
- 2020
-
Abstract
- <bold>Background: </bold>Aortic valve area (AVA) ≤1.0 cm2 is a defining characteristic of severe aortic stenosis (AS). AVA can be underestimated at low transvalvular flow rate. Yet, the impact of flow rate on prognostic value of AVA ≤1.0 cm2 is unknown and is not incorporated into AS assessment.<bold>Objectives: </bold>This study aimed to evaluate the effect of flow rate on prognostic value of AVA in AS.<bold>Methods: </bold>In total, 1,131 patients with moderate or severe AS and complete clinical follow-up were included as part of a longitudinal database. The effect of flow rate (ratio of stroke volume to ejection time) on prognostic value of AVA ≤1.0 cm2 for time to death was evaluated, adjusting for confounders. Sensitivity analysis was performed to identify the optimal cutoff for prognostic threshold of AVA. The findings were validated in a separate external longitudinal cohort of 939 patients.<bold>Results: </bold>Flow rate had a significant effect on prognostic value of AVA. AVA ≤1.0 cm2 was not prognostic for mortality (p = 0.15) if AVA was measured at flow rates below median (≤242 ml/s). In contrast, AVA ≤1.0 cm2 was highly prognostic for mortality (p = 0.003) if AVA was measured at flow rates above median (>242 ml/s). Findings were irrespective of multivariable adjustment for age, sex, and surgical/transcatheter aortic valve replacement (as time-dependent covariates); comorbidities; medications; and echocardiographic features. AVA ≤1.0 cm2 was also not an independent predictor of mortality below median flow rate in the validation cohort. The optimal flow rate cutoff for prognostic threshold was 210 ml/s.<bold>Conclusions: </bold>Transvalvular flow rate determines prognostic value of AVA in AS. AVA measured at low flow rate is not a good prognostic marker and therefore not a good diagnostic marker for truly severe AS. Flow rate assessment should be incorporated into clinical diagnosis, classification, and prognosis of AS. [ABSTRACT FROM AUTHOR]
- Subjects :
- *RESEARCH
*RESEARCH methodology
*AORTIC stenosis
*PROGNOSIS
*EVALUATION research
*MEDICAL cooperation
*DOPPLER echocardiography
*SEX distribution
*COMPARATIVE studies
*PROSTHETIC heart valves
*RESEARCH funding
*STROKE volume (Cardiac output)
*HEMODYNAMICS
*AORTIC valve
*ALGORITHMS
*LONGITUDINAL method
AORTIC valve surgery
Subjects
Details
- Language :
- English
- ISSN :
- 07351097
- Volume :
- 75
- Issue :
- 15
- Database :
- Academic Search Index
- Journal :
- Journal of the American College of Cardiology (JACC)
- Publication Type :
- Academic Journal
- Accession number :
- 142755873
- Full Text :
- https://doi.org/10.1016/j.jacc.2020.02.046