title: Prevalence and Prognostic Impact of Valve Area-Gradient Patterns in Patients ≥80 Years With Moderate-to-Severe Aortic Stenosis (from the Prospective BELFRAIL Study).
abstract: Although degenerative aortic valve stenosis (AS) is common with increasing age, limited data exist regarding the prevalence and prognostic impact of its various valve area-gradient patterns in patients ≥80 years. To test this, echocardiograms were obtained in 542 randomly selected subjects aged ≥80 years recruited in the Belgium Cohort Study of the Very Elderly study (BFC80+). Subjects were divided into 3 groups: no or mild AS, moderate AS, and severe AS. Patients with severe AS were further stratified into those with high mean gradients (HG-AS) and those with paradoxically low mean gradients (LG-AS). Prevalence of moderate-to-severe AS was 14.7% and that of severe AS was 5.9%. In patients with severe AS, most (72%) exhibited paradoxical LG-AS. All patients with severe HG-AS were asymptomatic at the time of inclusion, whereas 48% of those with severe paradoxical LG-AS had significant symptoms. During follow-up, there were 2 aortic valve replacements and 230 deaths, of which 100 (43%) were of cardiovascular origin. Five-year overall survival rate was significantly worse in severe HG-AS than in any of the other groups (22 ± 14% vs 62 ± 2% in no or mild AS, 48 ± 7% in moderate AS, and 43 ± 10% in severe paradoxical LG-AS, p <0.01). Survival rate was similar among severe paradoxical LG-AS with and without low flow. In conclusion, in this large population-based sample of subjects ≥80 years, the prevalence of severe AS was 5.9%. Most of these subjects presented with the severe paradoxical LG-AS and a third of them were symptomatic. In this elderly community, severe HG-AS is a major determinant of prognosis, even in the absence of symptoms, whereas severe paradoxical LG-AS seems to behave similarly to moderate AS.
authors.affiliation: Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Nawel
authors.initials: N
authors.lastname: Rezzoug
authors.affiliation: Institut de Recherche Santé-Société, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Bert
authors.initials: B
authors.lastname: Vaes
authors.affiliation: Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Agnès
authors.initials: A
authors.lastname: Pasquet
authors.affiliation: Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Gerber
authors.affiliation: Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Christophe
authors.initials: C
authors.lastname: de Meester
authors.affiliation: Institut de Recherche Santé-Société, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Gijs
authors.initials: G
authors.lastname: Van Pottelbergh
authors.affiliation: Institut de Recherche Santé-Société, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Adriaensen
authors.affiliation: Institut de Recherche Santé-Société, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Catharina
authors.initials: C
authors.lastname: Matheï
authors.affiliation: Institut de Recherche Santé-Société, Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: DeGryse
authors.affiliation: Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium. Electronic address: jean-louis.vanoverschelde@uclouvain.be.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vanoverschelde
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery; D058070:Asymptomatic Diseases; D002318:Cardiovascular Diseases / Q000401:mortality*; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D009929:Organ Size; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate