title: Clinical outcome in asymptomatic severe aortic stenosis: insights from the new proposed aortic stenosis grading classification.
abstract: OBJECTIVE
  This study examined the clinical course of patients with asymptomatic severe aortic stenosis (AS) according to the new proposed aortic valve stenosis grading classification.
  
  
  BACKGROUND
  The management of patients with asymptomatic severe AS remains controversial. Moreover, under the same denomination of severe AS, several entities might be identified according to transvalvular flow rates and pressure gradients, resulting in 4 flow-gradient patterns.
  
  
  METHODS
  Transthoracic echocardiography and measurement of B-type natriuretic peptide level from venous blood sample were performed in 150 consecutive patients with asymptomatic severe AS and normal exercise test. Patients were classified in 4 groups, depending on left ventricular flow state (normal flow [NF] vs. low flow [LF]: 35 ml/m(2)) and pressure gradient levels (low gradient [LG] vs. high gradient [HG]: 40 mm Hg).
  
  
  RESULTS
  Patients with NF/LG had significantly lower B-type natriuretic peptide than those with LF/HG and LF/LG. The mean follow-up was 27 ± 12 months. At 2 years, cardiac event-free survival was 83 ± 6%, 44 ± 6%, 30 ± 12%, and 27 ± 13% in NF/LG, NF/HG, LF/HG, and LF/LG groups, respectively (p < 0.0001). On multivariable analysis, LF/LG (hazard ratio [HR]: 5.26, 95% confidence interval [CI]: 2.04 to 14.3, p = 0.045) and LF/HG (HR: 2.38, 95% CI: 1.02 to 5.55, p = 0.001) were identified as strong independent determinants of poor prognosis as compared with NF/HG. By limiting the multivariable analysis to patients with LF, LF/LG was an independent predictor of markedly reduced cardiac event-free survival when compared with LF/HG (HR: 5.4, 95% CI: 1.03 to 28.6, p = 0.046).
  
  
  CONCLUSIONS
  The use of the new proposed AS grading classification integrating valve area and flow-gradient patterns allows a better characterization of the clinical outcome of patients with asymptomatic severe AS.
authors.affiliation: Department of Cardiology, Heart Valve Clinic, University Hospital Sart Tilman, University of Liège, Liège, Belgium. plancellotti@chu.ulg.ac.be
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
authors.forename: Julien
authors.initials: J
authors.lastname: Magne
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
authors.forename: Laurent
authors.initials: L
authors.lastname: Davin
authors.forename: Kim
authors.initials: K
authors.lastname: O'Connor
authors.forename: Monica
authors.initials: M
authors.lastname: Rosca
authors.forename: Catherine
authors.initials: C
authors.lastname: Szymanski
authors.forename: Bernard
authors.initials: B
authors.lastname: Cosyns
authors.forename: Luc A
authors.initials: LA
authors.lastname: Piérard
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000145:classification* / Q000401:mortality* / Q000503:physiopathology; D058070:Asymptomatic Diseases / Q000145:classification* / Q000401:mortality*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome