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Back to 2014 Annual Meeting Abstracts

Impact of Aortic Valve Replacement according to Echocardiographic markers of Aortic Stenosis Severity
Maxime Berthelot-Richer, Philippe Pibarot, Romain Capoulade, Jean G. Dumesnil, Abdelaziz Dahou, Florent Le Ven, Christophe Thebault, Marie-Annick Clavel.
Quebec Heart and Lung Institute Research Center, Québec, QC, Canada.

Background: Due to inherent discordance in the echocardiographic parameters cut-point used for severe aortic stenosis definition, discordant findings between aortic valve area (AVA<1.0cm2) and mean gradient (MG ≤ 40mmHg) is a frequent finding. To reconciliate these parameters, some authors suggested that the AVA threshold for severe aortic stenosis definition should be lowered to 0.8cm2. Our objective was to assess the survival benefit from aortic valve replacement (AVR) according to echocardiographic markers of AS severity: AVA, MG and peak aortic jet velocity (Vpeak).
Method: 837 patients with AS and normal flow (stroke volume indexed for body surface area >35 mL/m2 and left ventricular ejection fraction ≥ 50%), who underwent a conservative treatment or an isolated AVR, were separated into 4 strata of AS severity based on AVA, MG or Vpeak. We compared the effect of isolated AVR versus conservative therapy on survival in each strata of AS severity. A propensity score adjustment was used to eliminate covariate differences that may lead to biased estimates of treatment effect.
Results: Mean AVA was 1.06 ± 0.37cm2, mean gradient 28.9 ± 8.8mmHg and mean Vpeak 3.4±1.0m/s. 286 (34%) patients underwent an isolated AVR within 3 months following echocardiographic evaluation. During a mean follow-up of 4.4±3.0 years there were 282 deaths. In multivariate analysis, patients with an AVA between 0.8 and 1 cm2 had a significant survival benefit from AVR (Hazard ratio of AVR = 0.40 [0.10-0.94]; p=0.04). Of note, a survival benefit from AVR was also observed in patients with MG between 25 to 40mmHg or Vpeak between 3 to 4m/s (Figure).
Conclusion: These results do not support the suggestion of decreasing AVA threshold value for severe AS to 0.8 cm2 and they confirm that AVR may be beneficial in a substantial number of patients with an AVA<1cm2 despite a MG <40mmHg or a Vpeak<4m/s.

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