Table 1.
Prospective studies assessing risk stratification in moderate-to-severe asymptomatic AS
| Author | N | Severity | CAD | Outcome | Follow-up: months | AVR | Total/cardiac deaths | SCD | Outcome predictor |
|---|---|---|---|---|---|---|---|---|---|
| Rosenhek et al10 | 128 | Severe (>4 m/s) | Not exclude | Death, AVR | 22±18 | 59 of 106 (56%) | 8 6 cardiac |
1 (0.9%) | Calcification, rapid progression |
| Amato et al13 | 66 | Severe (AVA <1 cm2) | Excluded (angio) | Death, symptoms | 15±12 | ?34 | 4 | 4 (6.1%) | AVA <0.7 cm2, positive ETT |
| Lancellotti et al14 | 69 | Severe (AVA <1 cm2) | Not excluded | Symptoms, death, AVR | 15±7 | 12 (17%) | 3 cardiac + 1 death post-AVR | 2 (2.9%) SCD | Exercise mean PG +ve ETT, AVA <0.75 cm2 |
| Das et al15 | 125 | Moderate-to–severe (AVA <1.4 cm2), | Not excluded | Symptoms, death | 12 | 36 (29%) symptoms? AVR | No deaths | No SCD | Exercise symptoms |
| Monin et al40 | 104 | Moderate-to-severe: >3 m/s AVA <1.5 cm | RWMA exclude | Indication for AVR, death | 24 | 58 AVR | 4 deaths (1 post-AVR) | Female sex, BNP, peak velocity | |
| Rosenhek et al12 | 116 | Very severe >5 m/s | Not excluded | Indication for AVR, death | 41 (median) | 79 AVR, 10 refused AVR | 17 deaths 9 no surgery 8 post-AVR |
1 SCD | Peak AV >5.5 m/s, diabetes, cholesterol |
| Kang et al11 | 197 | Very severe >4.5 m/s or AVA <0.75 cm2 | History or RWMA | Death | 42 AVR 58 medical |
148 102 early, 46 (of 95) medical |
3 (0 cardiac) early, 28 (12 cardiac) medical | 9 (10%) medical 0 early |
Peak AV >5 m/s |
| Cioffi et al20 | 209 | Severe (AVA<1 cm2 or mean PG>40 mm Hg | History | Death, AVR, MI, HF hospitalisation | 22±13 | 72 | 20 (16 cardiac) | 2 SCD | Inappropriate high LVMI, peak velocity, calcification |
Source: Adapted from ref. 9-reproduced with permission.
Angio, coronary angiography; AS, aortic stenosis; AV, aortic valve velocity; AVA, aortic valve area; AVR, aortic valve replacement; BNP, brain natriuretic peptide; CAD, coronary artery disease; ETT, exercise tolerance test; HF, heart failure; LVMI, left ventricular mass index; MI, myocardial infarction; PG, pressure gradient; RWMA, regional wall motion abnormalities; SCD, sudden cardiac death.