Does increased valvuloarterial impedance predict overall mortality in asymptomatic patients with at least moderate aortic stenosis?
Valvuloarterial impedance > 3.5 mm Hg x ml(-1) x m(2) is a strong predictor of mortality in asymptomatic patients with moderate to severe aortic stenosis, improving risk stratification beyond standard severity indices.
OBJECTIVES This study was designed to examine the prognostic value of valvuloarterial impedance (Z(va)) in patients with aortic stenosis (AS). BACKGROUND We previously showed that the Z(va) is superior to standard indexes of AS severity in estimating the global hemodynamic load faced by the left ventricle (LV) and predicting the occurrence of LV dysfunction. This index is calculated by dividing the estimated LV systolic pressure (systolic arterial pressure + mean transvalvular gradient) by the stroke volume indexed for the body surface area. METHODS We retrospectively analyzed the clinical and echocardiographic data of 544 consecutive patients having at least moderate AS (aortic jet velocity > or =2.5 m.s(-1)) and no symptoms at baseline. The primary end point for this study was the overall mortality regardless of the realization of aortic valve replacement (AVR). RESULTS Four-year survival was significantly (p or =4.5 mm Hg x ml(-1) x m(2) (65 +/- 5%) compared with those with Z(va) between 3.5 and 4.5 mm Hg x ml(-1) x m(2) (78 +/- 4%) and those with Z(va) or =4.5 mm Hg x ml(-1) x m(2) and by 2.30-fold in those with a Z(va) between 3.5 and 4.5 mm Hg x ml(-1) x m(2) after adjusting for other risk factors and type of treatment (surgical vs. medical). CONCLUSIONS Increased Z(va) is a marker of excessive LV hemodynamic load, and a value >3.5 successfully identifies patients with a poor outcome. These findings suggest that beyond standard indexes of stenosis severity, the consideration of Z(va) may be useful to improve risk stratification and clinical decision making in patients with AS.
Hachicha et al. (2009) studied this question.