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DOI: 10.1016/j.rec.2019.11.004
Available online 8 January 2020
Prognostic value of aortic valve area normalized to body size in native aortic stenosis
Valor pronóstico del área valvular aórtica indexada en la estenosis valvular aórtica
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Sergio Gamaza Chulián
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gamaza80@hotmail.com

Corresponding author: Servicio de Cardiología, Hospital Universitario de Jerez, Carretera Madrid-Cádiz s/n, 11407 Jerez de la Frontera, Cádiz, Spain.
, Enrique Díaz Retamino, Rocío Carmona García, Bárbara Serrano Muñoz, Javier León Jiménez, Soraya González Estriégana, Jesús Oneto Otero
Servicio de Cardiología, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, Spain
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Tables (5)
Table 1. Baseline characteristics according to AVA/BSA
Table 2. Baseline echocardiographic characteristics according to AVA/BSA
Table 3. Baseline characteristics according to AVA/height
Table 4. Baseline echocardiographic characteristics according to AVA/height
Table 5. Relative risk of cardiovascular mortality during follow-up associated with AVA/BSA and AVA/height
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Abstract
Introduction and objectives

Although guidelines recommend the use of a cutoff value of 0.60 cm2/m2 for aortic valve area (AVA) normalized to body surface area (BSA) for severe aortic stenosis, there is little evidence of its prognostic value. Our aim was to test the value of AVA normalized to body size for outcome prediction in aortic stenosis.

Methods

One-hundred and ninety patients with at least moderate aortic stenosis (AVA <1.50 cm2) were prospectively enrolled. AVA was normalized to BSA and height. The primary endpoint was cardiovascular death under medical management. A receiver operating characteristic curve was plotted to determine the best cutoff value for predicting cardiovascular death.

Results

An AVA/BSA cutoff value of 0.50 had a sensitivity of 96% and specificity of 51%. An AVA/height cutoff value of 0.49 showed a sensitivity of 96% and a specificity of 52%. During a mean follow-up of 247±190 days, there were 24 cardiovascular deaths, with higher cardiovascular mortality in patients with AVA/BSA <0.50 cm2/m2 (21% vs 2.5%, P <.001) and AVA/height <0.49 cm2/m (25% vs 12%, P <.001). Two-year survival was 95±5% in patients with AVA/BSA> 0.50 cm2/m2 and was 37±5% in patients with AVA/BSA <0.50 cm2/m2 (P <.001). Cardiovascular death risk was higher in patients with AVA/BSA <0.50 cm2/m2 (adjusted 10.9 [1.2-103.7], P=.037), but cardiovascular mortality was not significantly higher in multivariate analysis for patients with AVA/height <0.49 cm2/m (2.0 [0.6-6.0], P=.22).

Conclusions

We could identify a subgroup of patients at high risk of cardiovascular death when they were medically treated. Consequently we recommend using an AVA/BSA cutoff value of 0.50 cm2/m2 to identify a subgroup of patients with higher cardiovascular risk.

Keywords:
Aortic stenosis
Echocardiography
Prognosis
Abbreviations:
AS
AVA
BSA
Resumen
Introducción y objetivos

Aunque se recomienda 0,60 cm2/m2 para el área valvular aórtica (AVA) indexada por superficie corporal (SC) para el diagnóstico de estenosis aórtica (EA) grave, existe poca evidencia de su valor pronóstico. Nuestro objetivo fue analizar el valor de AVA/SC para predecir eventos cardiovasculares en EA.

Métodos

Se incluyeron prospectivamente 190 pacientes con al menos EA moderada (AVA <1,50 cm2). El AVA se indexó por superficie corporal (AVA/SC) y por altura. El objetivo primario fue la mortalidad cardiovascular en pacientes bajo tratamiento médico. Se realizó una curva receiver operating characteristic para establecer el mejor punto de corte para predecir el objetivo primario.

Resultados

Un punto de corte de 0,50 para AVA/SC tuvo una sensibilidad del 96% y una especificidad del 51%. Un punto de corte de 0,49 en AVA/altura mostró una sensibilidad del 96% y una especificidad del 52%. Durante un seguimiento medio de 247±190 días, hubo 24 muertes cardiovasculares, con mayor incidencia en pacientes con AVA/SC <0,50 cm2/m2 (el 21 frente al 2,5%, p <0,001) y AVA/altura <0,49 cm2/m (el 25 frente al 12%, p <0,001). La supervivencia a 2 años de pacientes con AVA/SC> 0,50 cm2/m2 fue de 95±5%, mientras los pacientes con AVA/SC <0,50 cm2/m2 fue de 37±5% (p <0,001). El riesgo de muerte cardiovascular fue mayor en pacientes con AVA/SC <0,50 cm2/m2 (ajustado 10.9 [1,2-103,7], p=0,037), pero no fue significativamente mayor en AVA/altura <0,49 cm2/m en el análisis multivariante (2,0 [0,6-6,0], p=0,22).

Conclusiones

Nuestro estudio identificó un subgrupo de pacientes con EA de mayor riesgo de mortalidad cardiovascular, por lo que podría proponerse un punto de corte de AVA/SC de 0,50 cm2/m2 para identificar un subgrupo de pacientes de mayor riesgo cardiovascular.

Palabras clave:
Estenosis aórtica
Ecocardiografía
Pronóstico

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