RT Journal Article SR Electronic T1 Risk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP 1364 OP 1371 DO 10.1136/hrt.2009.190942 VO 96 IS 17 A1 Patrizio Lancellotti A1 Erwan Donal A1 Julien Magne A1 Marie Moonen A1 Kim O'Connor A1 Jean-Claude Daubert A1 Luc A Pierard YR 2010 UL http://heart.bmj.com/content/96/17/1364.abstract AB 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.