How Should Very Severe Aortic Stenosis Be Defined in Asymptomatic Individuals?

Figure 1. Mortality analysis of 785 asymptomatic patients (mean age 73 years, 53% males) with severe AS (AVA <1 cm2), preserved ejection fraction (LVEF ≥ 50%), and low surgical risk (EuroSCORE II ≤4%) managed medically and surgically in 3 European centers (Amiens, France; Lille, France; and Brussels, Belgium). The figure depicts the adjusted mortality of patients with VSAS (Vmax >5 m/s, or MPG ≥60 mm Hg, or AVA <0.6 cm2, or indexed AVA <0.4 cm2/m2, n=365, 46.5%) compared with that of patients with severe AS not fulfilling any of the VSAS diagnostic criteria (n=420, 53.5%). Curves are adjusted for age, sex, EuroSCORE II, coronary artery disease, atrial fibrillation, LVEF, and AVR using a time‐dependent methodology (Tribouilloy et al, unpublished data, 2019). AS indicates aortic stenosis; AVA, aortic valve area; AVR, aortic valve replacement; HR, hazard ratio; LVEF, left ventricular ejection fraction; MPG, mean transaortic pressure gradient; VSAS, very severe aortic stenosis.