Key result
Mild aortic stenosis, defined by novel MRI-derived criteria, was associated with an increased risk of all-cause mortality (HR 1.25) compared to individuals without aortic stenosis.
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Why the study?
Mild aortic stenosis is associated with adverse outcomes but remains incompletely defined.
Does mild aortic stenosis, defined by novel hemodynamic thresholds, increase the risk of adverse clinical outcomes in the general population?
Cohort (n=428,772)
Yes
Does mild aortic stenosis, defined by novel hemodynamic thresholds, increase the risk of adverse clinical outcomes in the general population?
A novel, empirically derived threshold for mild aortic stenosis identifies a large population at increased risk for adverse cardiovascular outcomes and mortality, challenging current guideline definitions.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Kany et al were successful in using these techniques and data to show that even a mild difference in valve area can lead to major change in prognosis, and consequently suggest that this new classification of mild AS that they propose should be used by clinical guidelines and in further research.”
“The findings suggest that even mild cases, previously considered benign, are linked to increased cardiovascular risks, highlighting the potential for early intervention and the critical role of AI in advancing cardiovascular research.”
Novel thresholds link mild aortic stenosis to higher mortality; hypothesis-generating and should not yet alter guideline grading or practice.
Background: Mild aortic stenosis is associated with adverse outcomes but is incompletely defined. Objective: To study the epidemiology of AV function measured without clinical indications. Methods: We developed a deep learning model to measure AV area (AVA), peak velocity (PV), and mean gradient (MG) in velocity-encoded MRI in 62,902 UK Biobank participants. Study findings were externally validated in the National Echo Database Australia (NEDA), a clinical cohort of 365,870 people. Results: From measuring reference ranges of AV function in a healthy sub-cohort (N=41,859), we observed a natural boundary between normal and abnormal AV hemodynamics (>95th percentile) that we refer to as “mild ASproposed”: PV >1.65m/s, MG >4.9mmHg, or AVA <2.1cm2 (men) or <1.7cm2 (women). In the full cohort, 3,676 (5.8%) participants met these novel criteria; the HR for a subsequent AV replacement for each severity category was 31.7 (mild ASproposed), 522.4 (moderate AS), and 3057.4 (severe AS), all P<0.001. Over a mean 3.9 years of follow-up, those with mild ASproposed also had a higher risk of atrial fibrillation (N events=110, HR 1.86, P=1.4×10−09) and heart failure (N=70, HR 2.37, P=5.9×10−11) compared with those without AS. In NEDA, the 101,335 participants with mild ASproposed identified with echocardiography using the same MRI-defined criteria had increased all-cause mortality (HR 1.25, 95%-CI 1.24-1.27). Conclusion: We report a large-scale study of AV hemodynamics and identify a population threshold between normal and abnormal AV function. Mild AS, as defined by the proposed criteria, was linked to adverse outcomes in the UK Biobank and in NEDA.
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Kany et al. (2025) conducted a cohort in Aortic stenosis (n=428,772). Mild aortic stenosis (mild ASproposed) vs. No aortic stenosis was evaluated on All-cause mortality (NEDA cohort) (HR 1.25, 95% CI 1.24-1.27). Mild aortic stenosis, defined by novel MRI-derived criteria, was associated with an increased risk of all-cause mortality (HR 1.25) compared to individuals without aortic stenosis.
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