Key result
Classic low-flow, low-gradient aortic stenosis linked to ~453% higher MACCE risk after SAVR.
Why the study?
It is unclear whether cardiac CT findings have additional value to discriminate significant aortic stenosis subtypes and affect post-surgical outcomes after AVR.
Does preoperative cardiac CT classification of severe aortic stenosis subtypes predict major adverse cardiac and cerebrovascular events after surgical aortic valve replacement?
Cohort (n=511)
No
Does preoperative cardiac CT classification of severe aortic stenosis subtypes predict major adverse cardiac and cerebrovascular events after surgical aortic valve replacement?
Preoperative cardiac CT provides incremental prognostic value in severe aortic stenosis, with classic LF-LG AS and smaller aortic annulus size independently predicting adverse outcomes after surgical AVR.
Answers are grounded in this paper and cite their sources.
Classic LF-LG AS may warrant closer post-SAVR surveillance; leaves open whether CT subtypes should guide decisions.
Aortic valve calcium scoring by cardiac computed tomographic (CT) has been recommended as an alternative to classify the AS (aortic stenosis) severity, but it is unclear that whether CT findings would have additional value to discriminate significant AS subtypes including high gradient severe AS, classic low-flow, low gradient (LF-LG) AS, paradoxical LF-LG AS, and moderate AS. In this study, we examined the preoperative clinical and cardiac CT findings of different subtypes of AS in patients with surgical aortic valve replacement (AVR) and evaluated the subtype classification as a factor affecting post-surgical outcomes. This study included 511 (66.9 ± 8.8 years, 55% men) consecutive patients with severe AS who underwent surgical AVR. Aortic valve area (AVA) was obtained by echocardiography (AVA echo ) and by CT (AVA CT ) using each modalities measurement of the left ventricular outflow tract. Patients with AS were classified as (1) high-gradient severe (n = 438), (2) classic LF-LG (n = 18), and (3) paradoxical LF-LG (n = 55) based on echocardiography. In all patients, 455 (89.0%) patients were categorized as severe AS according to the AVA CT . However, 56 patients were re-classified as moderate AS (43 [9.8%] high-gradient severe AS, 5 [27.8%] classic LF-LG AS, and 8 [14.5%] paradoxical LF-LG AS) by AVA CT . The classic LF-LG AS group presented larger AVA CT and aortic annulus than those in high-gradient severe AS group and one third of them had AVA CT ≥ 1.2 cm 2 . After multivariable adjustment, old age (hazard ratio [HR], 1.04, P = 0.049), high B-type natriuretic peptide (BNP) (HR, 1.005; P < 0.001), preoperative atrial fibrillation (HR, 2.75; P = 0.003), classic LF-LG AS (HR, 5.53, P = 0.004), and small aortic annulus on CT (HR, 0.57; P = 0.002) were independently associated with major adverse cardiac and cerebrovascular events (MACCE) after surgical AVR.
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Ahn et al. (2022) conducted a cohort in Severe aortic stenosis (n=511). Classic low-flow, low-gradient (LF-LG) aortic stenosis vs. High-gradient severe aortic stenosis was evaluated on Major adverse cardiac and cerebrovascular events (MACCE) (HR 5.53, 95% CI 1.74-17.56, p=0.004). Classic low-flow, low-gradient aortic stenosis was independently associated with a significantly higher risk of major adverse cardiac and cerebrovascular events (HR 5.53) after surgical aortic valve replacement.
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