PT  - JOURNAL ARTICLE
AU  - Romain Capoulade
AU  - Florent Le Ven
AU  - Marie-Annick Clavel
AU  - Jean G Dumesnil
AU  - Abdellaziz Dahou
AU  - Christophe Thébault
AU  - Marie Arsenault
AU  - Kim O'Connor
AU  - Élisabeth Bédard
AU  - Jonathan Beaudoin
AU  - Mario Sénéchal
AU  - Mathieu Bernier
AU  - Philippe Pibarot
TI  - Echocardiographic predictors of outcomes in adults with aortic stenosis
AID  - 10.1136/heartjnl-2015-308742
DP  - 2016 Jun 15
TA  - Heart
PG  - 934--942
VI  - 102
IP  - 12
4099  - http://heart.bmj.com/content/102/12/934.short
4100  - http://heart.bmj.com/content/102/12/934.full
SO  - Heart2016 Jun 15; 102
AB  - Objective The study purpose was to assess the usefulness of echocardiographic parameters of aortic stenosis (AS) severity and left ventricular (LV) systolic function to predict mortality in AS. The main hypothesis is that parameters of LV systolic function are the most important independent predictors of mortality, whereas parameters of stenosis severity are not.Methods 1065 consecutive patients with AS referred to the echocardiography laboratory and meeting the inclusion/exclusion criteria were included and followed during 5.7 years. The end points were aortic valve replacement (AVR) (n=584), composite of AVR or death (n=932), all-cause mortality (n=550) and cardiovascular mortality (n=398).Results The most powerful echocardiographic predictors of valve-related events were parameters of AS severity, such as peak aortic jet velocity (VPeak), mean gradient (MG) and aortic valve area (AVA) (all p<0.001). Regarding mortality, the main predictors were LV ejection fraction (LVEF) and stroke volume index (SVi) (p<0.05). After multivariable adjustment, LVEF (p<0.001) and SVi (p=0.02) remained the only echocardiographic predictors of mortality, even after adjustment for symptomatic status. AVA was also associated with mortality, whereas VPeak and MG were not.Conclusions The most powerful echocardiographic predictors of mortality are low LVEF and low flow, whereas AS severity parameters predict valve-related events but not overall mortality. Hence, low flow should be integrated in the risk stratification and therapeutic decision-making in patients with AS.