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Background  The aim of this study was to evaluate the relationship between aortic valve area ( AVA ) obtained by Doppler echocardiography and outcome in patients with severe asymptomatic aortic stenosis and to define a specific threshold of  AVA  for identifying asymptomatic patients at very high risk based on their clinical outcome.    Methods and Results  We included 199 patients with asymptomatic severe aortic stenosis ( AVA  ≤1.0 cm 2 ). The risk of events (death or need for aortic valve replacement) increased linearly on the scale of log hazard with decreased  AVA  (adjusted hazard ratio 1.17; 95%  CI  1.06–1.29 per 0.1 cm 2   AVA  decrement;  P =0.002). Event‐free survival at 12, 24, and 48 months was 63±6%, 51±6%, and 34±6%, respectively, for  AVA  0.8 to 1 cm 2 ; 49±6%, 36±6%, and 26±6%, respectively, for  AVA  0.6 to 0.8 cm 2 ; and 33±8%, 20±7%, and 11±5%, respectively, for  AVA  ≤0.6 cm 2  ( P  trend =0.002). Patients with  AVA  ≤0.6 cm 2  had a significantly increased risk of events compared with patients with  AVA  0.8 to 1 cm 2  (adjusted hazard ratio 2.22; 95%  CI  1.41–3.52;  P =0.001), whereas patients with  AVA  0.6 to 0.8 cm 2  had an increased risk of events compared with those with  AVA  0.8 to 1 cm 2 , but the difference was not statistically significant (adjusted hazard ratio 1.38; 95%  CI  0.93–2.05;  P =0.11). After adjustment for covariates and aortic valve replacement as a time‐dependent variable, patients with  AVA  ≤0.6 cm 2  had a significantly greater risk of all‐cause mortality than patients with  AVA  >0.6 cm 2  (hazard ratio 3.39; 95%  CI  1.80–6.40;  P <0.0001).    Conclusions  Patients with severe asymptomatic aortic stenosis and  AVA  ≤0.6 cm 2  displayed an important increase in the risk of adverse events during short‐term follow‐up. Further studies are needed to determine whether elective aortic valve replacement improves outcome in this high‐risk subgroup of patients.

Prognostic Value of Aortic Valve Area by Doppler Echocardiography in Patients With Severe Asymptomatic Aortic Stenosis