Open AccessPrognostic Impact of Peak Aortic Jet Velocity in Conservatively Managed Patients With Severe Aortic Stenosis: An Observation From the CURRENT AS Registry
Author(s) -
Nakatsuma Kenji,
Taniguchi Tomohiko,
Morimoto Takeshi,
Shiomi Hiroki,
Ando Kenji,
Kanamori Norio,
Murata Koichiro,
Kitai Takeshi,
Kawase Yuichi,
Izumi Chisato,
Miyake Makoto,
Mitsuoka Hirokazu,
Kato Masashi,
Hirano Yutaka,
Matsuda Shintaro,
Inada Tsukasa,
Nagao Kazuya,
Murakami Tomoyuki,
Takeuchi Yasuyo,
Yamane Keiichiro,
Toyofuku Mamoru,
Ishii Mitsuru,
MinaminoMuta Eri,
Kato Takao,
Inoko Moriaki,
Ikeda Tomoyuki,
Komasa Akihiro,
Ishii Katsuhisa,
Hotta Kozo,
Higashitani Nobuya,
Kato Yoshihiro,
Inuzuka Yasutaka,
Maeda Chiyo,
Jinnai Toshikazu,
Morikami Yuko,
Saito Naritatsu,
Minatoya Kenji,
Kimura Takeshi
Publication year - 2017
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.117.005524
Subject(s) - medicine , stenosis , cardiology , jet (fluid) , radiology , mechanics , physics
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.