title: Risk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay.
abstract: OBJECTIVE
  We sought to evaluate prognostic markers of clinical outcome in asymptomatic patients with moderate to severe aortic stenosis (AS).
  
  
  METHODS
  Prospective follow-up of asymptomatic patients with moderate to severe AS. The patients underwent clinical and Doppler echocardiographic evaluation.
  
  
  METHODS
  Department of Cardiology.
  
  
  METHODS
  163 patients with moderate to severe AS (aortic valve area < or =0.6 cm(2)/m(2)).
  
  
  METHODS
  Risk stratification. Predefined endpoints for assessing the outcome were the occurrence during follow-up of symptoms, aortic valve replacement or death.
  
  
  RESULTS
  During follow-up (mean, 20 (19) months), 11 patients developed symptoms but were not operated on, 57 required aortic valve replacement and six patients died. In multivariable Cox regression analysis, four parameters that were associated with the outcome were identified: peak aortic jet velocity, left ventricular systolic (LV) longitudinal deformation, valvulo-arterial impedance and indexed left atrial area. Using receiver-operator characteristic curve analysis, a peak aortic jet velocity > or =4.4 m/s, a LV longitudinal myocardial deformation < or =15.9%, a valvular-arterial impedance > or =4.9 mm Hg/ml per m(2) and an indexed left atrial area > or =12.2 cm(2)/m(2) were identified as the best cut-off values to be associated with events.
  
  
  CONCLUSIONS
  In asymptomatic patients with moderate to severe AS, measurements that integrate the ventricular, vascular and valvular components of the disease improve risk stratification.
authors.affiliation: Department of Cardiology, University Hospital Sart Tilman, Liège, Belgium. plancellotti@chu.ulg.ac.be
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
authors.forename: Julien
authors.initials: J
authors.lastname: Magne
authors.forename: Marie
authors.initials: M
authors.lastname: Moonen
authors.forename: Kim
authors.initials: K
authors.lastname: O'Connor
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Daubert
authors.forename: Luc A
authors.initials: LA
authors.lastname: Pierard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D001783:Blood Flow Velocity / Q000502:physiology; D015150:Echocardiography, Doppler; D004812:Epidemiologic Methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016277:Ventricular Function, Left / Q000502:physiology