Comparison between characteristics of severe and very severe aortic stenosis

Objectives Patients with very severe aortic stenosis ( AS ) have extremely poor clinical outcomes even if they are asymptomatic compared to those with severe AS , but the clinical and echocardiographic characteristics of patients with very severe AS remain unclear. Methods The Asian Valve Registry is a prospective, multicenter, multinational registry for the study and identification of the incidence, natural course, clinical outcomes, and prognostic factors for patients with significant AS at 9 centers in Asian countries. Severe AS was observed in 367 of 1066 patients with AS , and 212 were classified as very severe AS , defined as a peak aortic valve velocity ≥5.0 m/s or a mean aortic valve gradient ≥60 mm Hg. Results The prevalence of NYHA functional class II – IV among patients with very severe AS was significantly higher than that among patients with severe AS (67.9% vs 51.5%, P  < .001). As for echocardiographic parameters, it was noteworthy that left ventricular mass index ( LVMI ) and left atrial volume index ( LAVI ) for patients with very severe AS were significantly larger than those for patients with severe AS ( LVMI : 145.1 ± 36.4 g/m 2 vs 119.2 ± 32.1 g/m 2 , P  < .0001; LAVI : 56.1 ± 24.6 mL/m 2 vs 49.8 ± 22.6 mL/m 2 , P  = .002). Moreover, multivariate logistic regression analysis showed that LVMI was the only independently associated with NYHA functional class II – IV in patients with very severe AS . Conclusions Our findings may well have clinical implications for better management of patients with AS and lead to better understanding of poor outcomes for patients with very severe AS .