Transvalvular jet velocity, aortic valve area, mortality, and cardiovascular outcomes

Author:

Alcón Blanca1,Martínez-Legazpi Pablo2,Stewart Simon3,Gonzalez-Mansilla Ana1,Cuadrado Víctor4,Strange Geoff5ORCID,Yotti Raquel1,Cascos Enric1,Delgado-Montero Antonia1,Prieto-Arévalo Raquel1,Mombiela Teresa1,Rodríguez-González Elena1,Espinosa M Ángeles1,Postigo Andrea1,Gutiérrez-Ibanes Enrique1,Pérez-Vallina Manuel4,Fernández-Avilés Francisco1,Playford David5ORCID,Bermejo Javier1ORCID

Affiliation:

1. Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Dr. Esquerdo 46, 28007 Madrid, Spain

2. Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, UNED, and CIBERCV, Madrid, Spain

3. Torrens University Australia, Adelaide, South Australia, Australia

4. Department of Information and Communications, Hospital General Universitario Gregorio Marañón, Madrid, Spain

5. School of Medicine, University of Notre Dame, Fremantle, Australia

Abstract

Abstract Aims The interplay between aortic stenosis (AS), cardiovascular events, and mortality is poorly understood. In addition, how echocardiographic indices compare for predicting outcomes remains unexplored for the full range of AS severity. Methods and results We prospectively calculated peak jet velocity (Vmax) and aortic valve area (AVA) in 5994 adult subjects with and without AS. We linked ultrasound data to 5-year mortality and clinical events obtained from electronic medical records. Proportional-hazard and negative binomial regression models were adjusted for relevant covariables such as age, sex, comorbidities, stroke-volume, LV ejection fraction, left valve regurgitation, aortic valve sclerosis or calcification, and valve replacement. We observed a strong linear relationship between Vmax and all-cause mortality (hazard ratio: 1.26, 95% confidence interval: 1.19–1.33 per 100 cm/s), cardiovascular events, as well as incidental and recurrent heart failure (HF). Adjusted risks were highly significant even at Vmax values in the range of 150–200 cm/s, risk curves separating very early after the index exam. Vmax was not associated with coronary, arrhythmic, cerebrovascular, or non-cardiovascular events. Although risks were confirmed when AVA was entered in place of Vmax, the risks estimated for categories based on the two indices were mismatched, even in patients with normal flow. An external cohort comprising 112 690 patients confirmed augmented risks of all-cause and cardiovascular mortality starting at values of Vmax and AVA in the range of mild AS. Conclusions Aortic stenosis is strongly associated to all-cause mortality, cardiovascular mortality, and cardiac events, specifically HF. Risks increase in parallel to the degree of outflow obstruction but are apparent very early in patients with mild disease. Criteria for grading AS based on Vmax and AVA are mismatched in terms of outcomes.

Funder

NHMRC of Australia

Instituto de Salud Carlos III, Madrid Spain

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging,General Medicine

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