title: Prognostic stratification by conventional echocardiography of patients with aortic stenosis: the "CAIMAN-ECHO score".
abstract: OBJECTIVE
  Surgery is not recommended in asymptomatic patients with aortic stenosis (AS). However, prognosis of these patients is worse than retained. We built a simple score (named by the acronym "CAIMAN") for stratifying asymptomatic patients with AS according to the different risk for cardiovascular events.
  
  
  METHODS
  Data from 141 patients with moderate-to-severe AS followed up for 36 months were analyzed. The end point "outcome" was defined as death of all causes or aortic valve replacement imposed by symptoms or hospital admission for myocardial infarction and/or heart failure. The score was validated in 143 patients prospectively recruited in 2 different centers.
  
  
  RESULTS
  The 40 events occurred in the original cohort were associated with higher aortic transvalvular peak jet velocity, calcium score, and observed/predicted left ventricular (LV) mass ratio. Based on the hazard ratios of Cox analysis, the score was calculated as follows: calcium score 1-3 = 1 point, 4 = 6 points; transvalvular peak jet velocity ≤3.6 m/sec = 1 point, 3.6 m/sec = 3 points, observed/predicted LV mass ratio ≤110% = 1 point, >110% = 3 points. After a mean period of 28 ± 18 months, event-free survival was 18%, 42%, 91%, and 96% in the 4 quartiles of echo score. The accuracy of the score in predicting events was 84% and 77% (P = 0.09) in the original and validation cohort, respectively.
  
  
  CONCLUSIONS
  The CAIMAN-ECHO score is a simple and feasible tool useful for an accurate prognostic stratification of patients with asymptomatic moderate-to-severe AS.
authors.affiliation: Department of Cardiology, Villa Bianca Hospital, Trento, Italy. gcioffi@villabiancatrento.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.forename: Carmine
authors.initials: C
authors.lastname: Mazzone
authors.forename: Pompilio
authors.initials: P
authors.lastname: Faggiano
authors.forename: Luigi
authors.initials: L
authors.lastname: Tarantini
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.forename: Tiziano Edoardo
authors.initials: TE
authors.lastname: Russo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Selmi
authors.forename: Carlo
authors.initials: C
authors.lastname: Stefenelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Furlanello
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000601:surgery; D015897:Comorbidity; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality* / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality*; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome