title: Small aortic root in aortic valve stenosis: clinical characteristics and prognostic implications.
abstract: OBJECTIVE
  In aortic valve stenosis (AS), having a small aortic root may influence both the assessment of AS severity and the treatment strategy. The aim was to test the prognostic implications of having a small aortic root in AS within a large prospective study.
  
  
  RESULTS
  We used data from 4.3-year follow-up of 1560 patients with asymptomatic, initially mostly moderate AS enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study. A small aortic root was defined as inner aortic sinotubular junction diameter indexed for body height <1.4 cm/m in women and <1.5 cm/m in men. A small aortic root was found in 270 patients (17.3%) at baseline. Having a small aortic root was associated with larger aortic root wall thickness, higher pressure recovery, lower systemic arterial compliance, left ventricular mass index, and female sex in a multivariable logistic regression analysis (all P < 0.05). In the Cox regression analysis, having a small aortic root at baseline was associated with higher hazard rates of ischaemic cardiovascular events (n = 268; HR 1.55, 95% CI 1.16-2.06), non-haemorrhagic stroke (n = 55; HR 1.88, 95% CI 1.04-3.41), and cardiovascular death (n = 81; HR 2.08, 95% CI 1.28-3.39) (all P < 0.05) after adjusting for confounders, including randomized study treatment, sex, hypertension, AS severity, and aortic valve replacement.
  
  
  CONCLUSIONS
  In AS patients without known cardiovascular disease or diabetes, having a small aortic root was associated with increased ischaemic cardiovascular events and mortality. The results suggest a relation between the presence of a small aortic root and that of subclinical atherosclerosis.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT00092677.
authors.affiliation: Department of Cardiology, Asklepios Clinic St. Georg, II. Medical Clinic, Lohmühlenstrasse 5, 20099 Hamburg, Germany.
authors.forename: Edda
authors.initials: E
authors.lastname: Bahlmann
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
authors.forename: Dana
authors.initials: D
authors.lastname: Cramariuc
authors.affiliation: Department of Cardiology, Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Minners
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Mai Tone
authors.initials: MT
authors.lastname: Lønnebakken
authors.affiliation: Manchester Academic Health Sciences Centre, Manchester, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Ray
authors.affiliation: Department of Cardiology, Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Christa
authors.initials: C
authors.lastname: Gohlke-Baerwolf
authors.affiliation: Imperial College, The Royal Brompton & Harefield Trust, Cardiology & Aortic Centre, London, UK.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.affiliation: Department of Cardiology, Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Jander
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Seifert
authors.affiliation: Cardiothoracic Centre, Guys and St. Thomas Hospitals, London, UK.
authors.forename: John B
authors.initials: JB
authors.lastname: Chambers
authors.affiliation: Department of Cardiology, Asklepios Clinic St. Georg, II. Medical Clinic, Lohmühlenstrasse 5, 20099 Hamburg, Germany.
authors.forename: Karl Heinz
authors.initials: KH
authors.lastname: Kuck
authors.affiliation: Department of Clinical Science, University of Bergen, Bergen, Norway.
authors.forename: Eva
authors.initials: E
authors.lastname: Gerdts
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000187:drug effects; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D004452:Echocardiography; D000069438:Ezetimibe / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D019821:Simvastatin / Q000627:therapeutic use*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019821:Simvastatin; D000069438:Ezetimibe
keywords: aortic valve stenosis; energy loss index; prognosis; small aortic root