2175 JACC April 5, 2016 Volume 67, Issue 13
Valvular Heart Disease DIFFERENT CLINICAL OUTCOMES IN PATIENTS WITH ASYMPTOMATIC SEVERE AORTIC STENOSIS ACCORDING TO THE STAGE CLASSIFICATION Moderated Poster Contributions Valvular Heart Disease Moderated Poster Theater, Poster Area, South Hall A1 Sunday, April 03, 2016, 10:00 a.m.-10:10 a.m. Session Title: Valvular Heart Disease: AV - Bicuspid/Gender; Low Gradient/Preserved EF Abstract Category: 40. Valvular Heart Disease: Clinical Presentation Number: 1193M-03 Authors: Takeshi Kitai, Tomohiko Taniguchi, Takeshi Morimoto, Tadaaki Koyama, Yutaka Furukawa, Takeshi Kimura, Kobe City Medical Center General Hospital, Kobe, Japan, Kyoto University Graduate School of Medicine, Kyoto, Japan
Background: The 2014 ACC/AHA guidelines introduced a new classification of severe aortic stenosis (AS) based mainly on the maximal jet velocity (Vmax) and mean pressure gradient (MPG), but not on the aortic valve area (AVA). This study aimed to examine the clinical outcomes in asymptomatic severe AS according to the guideline classification.
Methods: We analyzed data from 1517 patients with asymptomatic severe AS enrolled in the CURRENT AS registry (Contemporary Outcomes After Surgery and Medical Treatment in Patients with Severe Aortic Stenosis) in whom surgery was not initially planned. Patients were divided into the 2 groups, excluding 5 patients with missing data for classification. Group 1 (N=122) consists of patients who met the recommendation for surgery including patients with left ventricular ejection fraction <50% and high gradient (HG) (Vmax ≥4.0 m/s or MPG ≥40 mmHg), and very HG (Vmax ≥5.0 m/s or MPG ≥60 mmHg). Group 2 (N=1390) consists of patients who did not meet recommendation for surgery. Group 2 were subdivided into HG (Group 2a, N=497) and low gradient (LG) (Vmax <4.0 m/s and MPG <40 mmHg) (Group 2b, N=893). The primary outcome measure was defined as a composite of aortic-valve related death and heart failure hospitalization. Results: The median follow-up was 1669 days. The cumulative incidence of the primary outcome measure was higher in Group 1 than in Group 2 (38.5% vs 22.9%, P<0.001). Even after adjusting for the confounders, the results remained significant (adjusted HR: 1.91, 95%CI: 1.38 to 2.59, P<0.001). Although the cumulative incidence of the primary outcome measure was similar between Group 2a and 2b (24.9% vs 21.8%, P=0.85), the higher adjusted risk of Group 2a relative to Group 2b was significant (adjusted HR: 1.39, 95%CI: 1.09 to 1.76, P=0.007). Conclusions: Among asymptomatic severe AS, patients who met recommendation for surgery in the current guideline as compared with those without were associated with significantly higher risk for serious adverse event when managed conservatively. The clinical outcome of the LG-AS with AVA <1.0 cm2, who were excluded from the severe AS category in the current guideline, was better than that of the HGAS without recommendation for surgery.