Baseline clinical and echocardiographic characteristics in the conservative management and initial AVR cohorts
| Variable | All patients | Conservative management cohort | Initial AVR cohort | ||||
| Normal LVMI (n=691) | High LVMI (n=1480) | p Value | Normal LVMI (n=217) | High LVMI (n=894) | p Value | ||
| Clinical characteristics | |||||||
| Age, years*† | 77.0 (9.6) | 77.8 (9.6) | 79.5 (9.2) | <0.001 | 71.6 (9.4) | 73.5 (8.8) | 0.0051 |
| Age ≥80 years | 1378 (42) | 321 (46) | 787 (53) | 0.0035 | 40 (18) | 230 (26) | 0.025 |
| Male* | 1275 (39) | 345 (50) | 457 (31) | <0.001 | 121 (56) | 352 (39) | <0.001 |
| BMI <22*‡ | 1822 (56) | 398 (58) | 878 (59) | 0.45 | 109 (50) | 437 (49) | 0.72 |
| BSA, m2 | 1.46 (0.18) | 1.47 (0.18) | 1.42 (0.18) | <0.001 | 1.54 (0.18) | 1.49 (0.18) | <0.001 |
| Hypertension* | 2326 (71) | 492 (71) | 1089 (74) | 0.25 | 133 (61) | 612 (68) | 0.044 |
| Current smoking* | 180 (5) | 31 (4) | 72 (5) | 0.70 | 15 (7) | 62 (7) | 0.99 |
| Diabetes mellitus | 806 (25) | 187 (27) | 365 (25) | 0.23 | 58 (27) | 196 (22) | 0.13 |
| On insulin therapy* | 177 (5) | 41 (6) | 82 (6) | 0.71 | 12 (6) | 42 (5) | 0.61 |
| Coronary artery disease* | 1036 (32) | 231 (33) | 441 (30) | 0.088 | 78 (36) | 286 (32) | 0.27 |
| Prior symptomatic stroke* | 428 (13) | 119 (17) | 209 (14) | 0.060 | 22 (10) | 78 (9) | 0.51 |
| Atrial fibrillation or flutter*† | 698 (21) | 157 (23) | 351 (24) | 0.61 | 43 (20) | 147 (16) | 0.24 |
| Serum creatinine, mg/dL* | 0.9 (0.56) | 0.89 (0.7–1.22) | 0.91 (0.7–1.49) | <0.001 | 0.79 (0.65–0.97) | 0.83 (0.69–1.16) | 0.022 |
| ESRD*§ | 486 (15) | 77 (11) | 270 (18) | <0.001 | 16 (7) | 123 (14) | 0.011 |
| Anaemia*¶ | 1784 (54) | 333 (48) | 873 (59) | <0.001 | 93 (43) | 485 (54) | 0.0026 |
| Liver cirrhosis (Child-Pugh B or C)* | 34 (1) | 6 (1) | 22 (1) | 0.23 | 0 (0) | 6 (0.7) | 0.60 |
| Malignancy currently under treatment*† | 133 (4) | 53 (8) | 57 (4) | <0.001 | 2 (1) | 21 (2) | 0.29 |
| Chronic lung disease (moderate or severe)* | 97 (3) | 21 (3) | 57 (4) | 0.34 | 2 (1) | 17 (2) | 0.56 |
| STS score (PROM), % | 3.8 (4.5) | 3.8 (2.3–6.2) | 4.8 (2.8–8.4) | <0.001 | 2.2 (1.5–3.7) | 2.9 (1.8–5.0) | <0.001 |
| Symptoms at index echocardiography | 1707 (52) | 181 (26) | 690 (47) | <0.001 | 147 (68) | 689 (77) | 0.0039 |
| Chest pain | 439 (13) | 46 (7) | 120 (8) | 0.23 | 60 (28) | 213 (24) | 0.25 |
| Syncope | 173 (5) | 18 (3) | 51 (3) | 0.29 | 26 (12) | 78 (9) | 0.15 |
| Chronic exertional dyspnoea | 1353 (41) | 147 (21) | 601 (41) | <0.001 | 84 (39) | 521(58) | <0.001 |
| Admission for heart failure at index echocardiography*† | 621 (19) | 66 (10) | 318 (21) | <0.001 | 21 (10) | 216 (24) | <0.001 |
| Echocardiographic variables | |||||||
| Vmax, m/s | 4.1 (0.9) | 3.6 (0.7) | 4.0 (0.9) | <0.001 | 4.4 (0.7) | 4.8 (0.8) | <0.001 |
| Vmax >4 m/s*† | 1863 (57) | 204 (30) | 740 (50) | <0.001 | 165 (76) | 754 (84) | 0.0037 |
| Peak aortic PG, mm Hg | 72 (32) | 53 (20) | 66 (29) | <0.001 | 80 (25) | 94 (33) | <0.001 |
| Mean aortic PG, mm Hg | 41 (20) | 30 (12) | 38 (18) | <0.001 | 47 (16) | 56 (20) | <0.001 |
| AVA (equation of continuity), cm2 | 0.72 (0.18) | 0.80 (0.14) | 0.74 (0.19) | <0.001 | 0.69 (0.16) | 0.64 (0.18) | <0.001 |
| Low gradient AS** | 1215 (37) | 426 (62) | 645(44) | <0.001 | 41 (19) | 103 (12) | 0.0029 |
| Low gradient AS with preserved LVEF†† | 966 (29) | 377 (55) | 491 (33) | <0.001 | 37 (17) | 61 (7) | <0.001 |
| AVA index, cm2/m2 | 0.50 (0.13) | 0.55 (0.11) | 0.52 (0.13) | <0.001 | 0.46 (0.11) | 0.43 (0.12) | 0.011 |
| LV end-diastolic diameter, mm | 46.1 (7.0) | 42.3 (5.5) | 47.1 (6.7) | <0.001 | 42.5 (5.1) | 48.4 (7.2) | <0.001 |
| LV end-systolic diameter, mm | 30.3 (7.9) | 27.2 (5.8) | 31.2 (7.9) | <0.001 | 26.1 (5.5) | 32.3 (8.7) | <0.001 |
| LVEF, % | 63 (13) | 65 (11) | 62 (14) | <0.001 | 69 (9) | 62 (14) | <0.001 |
| LVEF <68%*† | 1928 (59) | 393 (57) | 919 (62) | 0.021 | 92 (42) | 524 (59) | <0.001 |
| LVMI, g/m2 | 123 (101–151) | 89 (79–99) | 133 (117–157) | <0.001 | 91 (82–100) | 145 (124–206) | <0.001 |
| Any combined valvular disease (moderate or severe)*† | 1310 (40) | 199 (29) | 662 (45) | <0.001 | 60 (28) | 389 (44) | <0.001 |
| TR pressure gradient ≥40 mm Hg* | 516 (16) | 79 (11) | 269 (18) | <0.001 | 16 (7) | 152 (17) | <0.001 |
p Values were calculated from a χ2 test or Fisher’s exact test for categorical variables, and Student’s t-test or Wilcoxon rank sum test for continuous variables.
Values are number (%), mean (SD) or median (IQR).
*Potential risk-adjusting variables selected for Cox proportional hazard models.
†Potential risk-adjusting variables selected for parsimonious Cox proportional hazard models.
‡BMI was calculated as weight in kilograms divided by height in metres squared.
§ESRD was defined as creatinine level >2 mg/dL and/or haemodialysis.
¶Anaemia was defined by the WHO criteria (haemoglobin <12.0 g/dL in women and <13.0 g/dL in men).
**Low gradient AS=AVA<1 cm2, mean PG ≤40 mm Hg and Vmax ≤4 m/s.
††Low gradient AS with preserved LVEF=AVA <1 cm2, mean PG ≤40 mm Hg, Vmax ≤4 m/s and LVEF ≥50%.
AS, aortic stenosis; AVA, aortic valve area; AVR, aortic valve replacement; BMI, body mass index; BSA, body surface area; ESRD, end-stage renal disease; LV, left ventricular; LVEF, left ventricular ejection fraction; LVMI, left ventricular mass index; PG, pressure gradient; PROM, predicted risk of mortality; STS, Society of Thoracic Surgeons; TR, tricuspid regurgitation; Vmax, peak aortic jet velocity.