Key result
In conservatively managed severe aortic stenosis, Vmax ≥5 m/s was associated with a higher 5-year risk of AS-related events compared to 4.0-4.5 m/s (HR 1.53; 95% CI 1.17-2.00; P=0.002).
Why the study?
Does higher peak aortic jet velocity increase the risk of AS-related events in conservatively managed patients with severe AS and preserved LVEF?
Cohort (n=1,075)
Does higher peak aortic jet velocity increase the risk of AS-related events in conservatively managed patients with severe AS and preserved LVEF?
Hazard Ratio: 1.53 (95% CI 1.17–2)
Absolute Event Rate: 62.8% vs 38%
p-value: p=0.002
In conservatively managed severe AS with preserved LVEF, higher peak aortic jet velocity is associated with an incrementally higher risk of AS-related events, though risk remains high even in asymptomatic patients with lower Vmax.
May inform Vmax-based risk stratification in conservatively managed severe AS; leaves open whether higher-velocity thresholds should guide earlier intervention.
Background There are limited data regarding the risk stratification based on peak aortic jet velocity (Vmax) in patients with severe aortic stenosis ( AS ). Methods and Results Among 3815 consecutive patients with severe AS enrolled in the CURRENT AS (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis) registry, the study population consisted of 1075 conservatively managed patients with Vmax ≥4.0 m/s and left ventricular ejection fraction ≥50%. The study patients were subdivided into 3 groups based on Vmax (group 1, 4.0 ≤ Vmax <4.5 m/s, N=550; group 2, 4.5 ≤ Vmax <5 m/s, N=279; and group 3, Vmax ≥5 m/s, N=246). Cumulative 5‐year incidence of AS ‐related events (aortic valve–related death or heart failure hospitalization) was incrementally higher with increasing Vmax (entire population; 38.0%, 49.4%, and 62.8%, P <0.001; symptomatic patients; 55.7%, 60.9%, and 72.2%, P =0.008; and asymptomatic patients; 29.4%, 38.9%, and 47.7%, P =0.005). After adjusting for confounders, the excess risk of group 2 and group 3 relative to group 1 for AS ‐related events remained significant (hazard ratio, 1.39; 95% CI , 1.07–1.81; P =0.02, and hazard ratio, 1.53; 95% CI , 1.17–2.00; P =0.002, respectively). The effect size of group 3 relative to group 1 for AS ‐related events in asymptomatic patients (N=479) was similar to that in symptomatic patients (N=596; hazard ratio, 1.59; 95% CI , 1.01–2.52; P =0.047, and hazard ratio, 1.67; 95% CI , 1.16–2.40, P =0.008, respectively), and there was no significant overall interaction between the symptomatic status and the effect of the Vmax categories on AS ‐related events (interaction, P =0.88). Conclusions In conservatively managed severe AS patients with preserved left ventricular ejection fraction, increasing Vmax was associated with incrementally higher risk for AS ‐related events. However, the cumulative 5‐year incidence of the AS ‐related events remained very high even in asymptomatic patients with less greater Vmax.
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Nakatsuma et al. (2017) conducted a cohort in Severe aortic stenosis (n=1,075). Peak aortic jet velocity ≥5 m/s vs. Peak aortic jet velocity 4.0 to <4.5 m/s was evaluated on AS-related events (aortic valve–related death or heart failure hospitalization) (HR 1.53, 95% CI 1.17-2.00, p=0.002). In conservatively managed severe aortic stenosis, Vmax ≥5 m/s was associated with a higher 5-year risk of AS-related events compared to 4.0-4.5 m/s (HR 1.53; 95% CI 1.17-2.00; P=0.002).
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