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Risk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay
  1. Patrizio Lancellotti1,
  2. Erwan Donal2,
  3. Julien Magne1,
  4. Marie Moonen1,
  5. Kim O'Connor1,
  6. Jean-Claude Daubert2,
  7. Luc A Pierard1
  1. 1Department of Cardiology, University Hospital Sart Tilman, Liège, Belgium
  2. 2CHU de Ponchaillou, Rennes, France
  1. Correspondence to P Lancellotti, Department of Cardiology, University Hospital, Domaine Universitaire du Sart Tilman - B.35 - 4000 Liège, Belgium; plancellotti{at}


Objective We sought to evaluate prognostic markers of clinical outcome in asymptomatic patients with moderate to severe aortic stenosis (AS).

Design Prospective follow-up of asymptomatic patients with moderate to severe AS. The patients underwent clinical and Doppler echocardiographic evaluation.

Setting Department of Cardiology.

Patients 163 patients with moderate to severe AS (aortic valve area ≤0.6 cm2/m2).

Main outcome measures Risk stratification. Predefined endpoints for assessing the outcome were the occurrence during follow-up of symptoms, aortic valve replacement or death.

Results During follow-up (mean, 20 (19) months), 11 patients developed symptoms but were not operated on, 57 required aortic valve replacement and six patients died. In multivariable Cox regression analysis, four parameters that were associated with the outcome were identified: peak aortic jet velocity, left ventricular systolic (LV) longitudinal deformation, valvulo-arterial impedance and indexed left atrial area. Using receiver−operator characteristic curve analysis, a peak aortic jet velocity ≥4.4 m/s, a LV longitudinal myocardial deformation ≤15.9%, a valvular-arterial impedance ≥4.9 mm Hg/ml per m2 and an indexed left atrial area ≥12.2 cm2/m2 were identified as the best cut-off values to be associated with events.

Conclusions In asymptomatic patients with moderate to severe AS, measurements that integrate the ventricular, vascular and valvular components of the disease improve risk stratification.

  • Aortic stenosis
  • echocardiography
  • left ventricular function
  • exercise
  • valve surgery
  • aortic value disease

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  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Liège CHU Sart Tilman and CHU de Ponchaillou, Rennes, FRANCE.

  • Provenance and peer review Not commissioned; externally peer reviewed.