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Adjusting parameters of aortic valve stenosis severity by body size
  1. Jan Minners1,
  2. Christa Gohlke-Baerwolf1,
  3. Beat A Kaufmann2,
  4. Edda Bahlmann3,
  5. Eva Gerdts4,
  6. Kurt Boman5,
  7. John B Chambers6,
  8. Christoph A Nienaber7,
  9. Ronnie Willenheimer8,
  10. Kristian Wachtell9,
  11. Ingar Holme10,
  12. Terje R Pedersen10,
  13. Franz-Josef Neumann1,
  14. Nikolaus Jander1
  1. 1University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Germany
  2. 2Department of Cardiology, University Hospital Basel, Switzerland
  3. 3Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany
  4. 4Institute of Medicine, University of Bergen, Haukeland University Hospital, Bergen, Norway
  5. 5Department of Medicine, Skellefteå, Sweden/Institution of Public Health and Clinical Medicine, Umeå University, Sweden
  6. 6Cardiothoracic Centre, Guys and St Thomas' Hospital Trust, London, UK
  7. 7Heart Center Rostock, University of Rostock, Germany
  8. 8Heart Health Group and Lund University, Malmö, Sweden
  9. 9Department of Cardiology, Glostrup, Copenhagen, Denmark
  10. 10University of Oslo and Oslo University Hospital, Ullevål, Centre of Preventive Medicine, Oslo, Norway
  1. Correspondence to Dr Jan Minners, University Heart Center Freiburg, Suedring 15, 79189 Bad Krozingen, Germany; jan.minners{at}universitaets-herzzentrum.de

Abstract

Background Adjustment of cardiac dimensions by measures of body size appears intuitively convincing and in patients with aortic stenosis, aortic valve area (AVA) is commonly adjusted by body surface area (BSA). However, there is little evidence to support such an approach.

Objective To identify the adequate measure of body size for the adjustment of aortic stenosis severity.

Methods Parameters of aortic stenosis severity (jet velocity, mean pressure gradient (MPG) and AVA) and measures of body size (height, weight, BSA and body mass index (BMI)) were analysed in 2843 consecutive patients with aortic stenosis (jet velocity ≥2.5 m/s) and related to outcomes in a second cohort of 1525 patients from the Simvastatin/Ezetimibe in Aortic Stenosis (SEAS) study.

Results Whereas jet velocity and MPG were independent of body size, AVA was significantly correlated with height, weight, BSA and BMI (Pearson correlation coefficient (r) 0.319, 0.281, 0.317 and 0.126, respectively, all p<0.001) to the effect that larger patients presented with larger AVA (less severe stenosis). Of the anthropometric measures used for linear adjustment, BSA was most effective in eliminating the correlation between AVA and body size (r=0.007), rivalled only by allometric (non-linear) models, findings that are confirmed in 1525 prospectively followed patients from the SEAS study. Predictive accuracy for aortic valve events and cardiovascular death during 46 months of follow-up was unchanged by adjusting AVA, regardless of measure of body size (area under the receiver operating curve for AVA 0.72 (CI 0.58 to 0.87) versus, for example, AVA/BSA 0.75 (CI 0.61 to 0.88), p=0.22).

Conclusions In the assessment of aortic stenosis, linear adjustment of AVA by BSA improves comparability between patients with diverging body size without, however, increasing the predictive accuracy for clinical events in a population with mild to moderate stenosis.

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