Table 1.
Baseline Characteristics and Echocardiographic Parameters
| Group 1: AVA >0.8 cm2 (N=645) | Group 2: 0.8 cm2 ≥AVA >0.6 cm2 (N=465) | Group 3: AVA ≤0.6 cm2 (N=199) | P Value | |
|---|---|---|---|---|
| Clinical characteristics | ||||
| Age, y* | 76±9 | 78±9 | 81±9 | <0.001 |
| Age ≥80 y | 250 (38.8) | 233 (50.1) | 115 (57.8) | <0.001 |
| Male* | 296 (45.9) | 151 (32.6) | 56 (28.1) | <0.001 |
| BMI, kg/m² | 22.5±3.7 | 21.8±4.0 | 21.2±3.3 | <0.001 |
| BMI <22 kg/m²* | 338 (52.4) | 283 (60.9) | 142 (71.4) | <0.001 |
| BSA, m² | 1.50±0.18 | 1.44±0.17 | 1.40±0.17 | <0.001 |
| Hypertension* | 463 (71.8) | 333 (71.6) | 125 (62.8) | 0.04 |
| Current smoking* | 40 (6.2) | 14 (3.0) | 7 (3.5) | 0.03 |
| History of smoking | 159 (24.7) | 87 (18.7) | 29 (14.6) | 0.003 |
| Dyslipidemia | 250 (38.8) | 148 (31.8) | 62 (31.2) | 0.03 |
| On statin therapy | 200 (31.0) | 101 (21.7) | 41 (20.6) | <0.001 |
| Diabetes mellitus | 162 (25.1) | 113 (24.3) | 38 (19.1) | 0.21 |
| On insulin therapy* | 33 (5.1) | 19 (4.1) | 11 (5.5) | 0.64 |
| Prior myocardial infarction* | 41 (6.4) | 36 (7.7) | 14 (7.0) | 0.67 |
| Prior PCI | 112 (17.4) | 75 (16.1) | 23 (11.6) | 0.15 |
| Prior CABG | 31 (4.8) | 25 (5.4) | 8 (4.0) | 0.75 |
| Prior open heart surgery | 52 (8.1) | 50 (10.8) | 17 (8.5) | 0.29 |
| Prior symptomatic stroke* | 102 (15.8) | 65 (14.0) | 26 (13.1) | 0.54 |
| Atrial fibrillation or flutter* | 115 (17.8) | 91 (19.6) | 45 (22.6) | 0.31 |
| Aortic/peripheral vascular disease* | 94 (14.6) | 86 (18.5) | 29 (14.6) | 0.18 |
| Serum creatinine, mg/dL* | 0.9 (0.7–1.1) | 0.8 (0.7–1.2) | 0.8 (0.7–1.1) | 0.69 |
| Creatinine level >2 mg/dL | 73 (11.3) | 62 (13.3) | 26 (13.1) | 0.56 |
| Hemodialysis* | 56 (8.7) | 52 (11.2) | 23 (11.6) | 0.29 |
| Anemia*, † | 278 (43.1) | 219 (47.1) | 105 (52.8) | 0.05 |
| Liver cirrhosis (Child‐Pugh B or C)* | 4 (0.6) | 4 (0.9) | 1 (0.5) | 0.84 |
| Malignancy | 95 (14.7) | 75 (16.1) | 26 (13.1) | 0.58 |
| Malignancy currently under treatment* | 35 (5.4) | 30 (6.5) | 5 (2.5) | 0.12 |
| Chest wall irradiation | 5 (0.8) | 1 (0.2) | 1 (0.5) | 0.45 |
| Immunosuppressive therapy | 27 (4.2) | 15 (3.2) | 4 (2.0) | 0.32 |
| Chronic lung disease (moderate or severe)* | 15 (2.3) | 13 (2.8) | 7 (3.5) | 0.65 |
| Coronary artery disease* | 175 (27.1) | 116 (24.9) | 46 (23.1) | 0.47 |
| Logistic EuroSCORE, % | 7.7 (4.8–11.5) | 9.2 (5.8–15.5) | 10.7 (6.6–15.2) | <0.001 |
| EuroSCORE II, % | 2.1 (1.3–3.3) | 2.7 (1.7–3.8) | 2.9 (2.0–4.1) | <0.001 |
| STS score (PROM), % | 3.0 (2.0–4.6) | 3.7 (2.3–5.6) | 4.1 (2.8–5.9) | <0.001 |
| Etiology of aortic stenosis | 0.18 | |||
| Degenerative | 573 (88.8) | 414 (89.0) | 181 (91.0) | |
| Congenital | 43 (6.7) | 26 (5.6) | 9 (4.5) | |
| Rheumatic | 24 (3.7) | 23 (4.9) | 5 (2.5) | |
| Infective endocarditis | 0 (0.0) | 0 (0.0) | 1 (0.5) | |
| Other | 5 (0.8) | 2 (0.4) | 3 (1.5) | |
| Echocardiographic variables | ||||
| Vmax, m/s | 3.6±0.6 | 3.8±0.7 | 4.4±0.7 | <0.001 |
| Vmax ≥5 m/s | 12 (1.9) | 23 (4.9) | 47 (23.6) | <0.001 |
| 5.0 m/s >Vmax ≥4.5 m/s | 35 (5.5) | 48 (10.3) | 47 (23.6) | |
| 4.5 m/s >Vmax ≥4 m/s | 128 (19.9) | 121 (26.0) | 53 (26.6) | |
| Vmax <4 m/s | 467 (72.7) | 273 (58.7) | 52 (26.1) | |
| Peak aortic PG, mm Hg | 53±18 | 61±22 | 80±26 | <0.001 |
| MPG, mm Hg | 29±11 | 35±13 | 47±17 | <0.001 |
| MPG ≥60 mm Hg | 7 (1.3) | 18 (4.5) | 40 (23.4) | <0.001 |
| 60 mm Hg >MPG ≥40 mm Hg | 82 (14.7) | 107 (26.8) | 74 (43.3) | |
| MPG <40 mm Hg | 470 (84.1) | 274 (68.7) | 57 (33.3) | |
| Very severe AS (Vmax ≥5 m/s or MPG ≥60 mm Hg) | 13 (2.0) | 27 (5.8) | 52 (26.1) | <0.001 |
| AVA (equation of continuity), cm² | 0.92±0.08 | 0.73±0.06 | 0.52±0.07 | <0.001 |
| AVA index, cm²/m² | 0.62±0.08 | 0.52±0.07 | 0.38±0.06 | <0.001 |
| LV end‐diastolic diameter, mm | 45±6 | 44±5 | 43±5 | <0.001 |
| LV end‐systolic diameter, mm | 28±5 | 27±5 | 27±5 | 0.005 |
| LVEF, %* | 68±8 | 68±8 | 67±7 | 0.06 |
| IVST in diastole, mm | 10.8±2.1 | 11.0±2.0 | 11.5±2.3 | <0.001 |
| PWT in diastole, mm | 10.4±1.8 | 10.6±1.8 | 11.2±2.1 | <0.001 |
| Any combined valvular disease (moderate or severe)* | 218 (33.8) | 128 (27.5) | 62 (31.2) | 0.08 |
| Moderate or severe AR | 127 (19.7) | 56 (12.0) | 23 (11.6) | 0.001 |
| Moderate or severe MS | 21 (3.3) | 11 (2.4) | 5 (2.5) | 0.65 |
| Moderate or severe MR | 76 (11.8) | 43 (9.2) | 26 (13.1) | 0.26 |
| Moderate or severe TR | 82 (12.7) | 58 (12.5) | 32 (16.1) | 0.41 |
| TR pressure gradient ≥40 mm Hg* | 56 (8.7) | 52 (11.2) | 24 (12.1) | 0.24 |
Values are expressed as mean±SD, and number (%), or median (interquartile range). AR indicates aortic regurgitation; AS, aortic stenosis; AVA, aortic valve area; BMI, body mass index; BSA, body surface area; CABG, coronary artery bypass grafting; IVST, interventricular septum thickness; LV, left ventricular; LVEF, left ventricular ejection fraction; MPG, mean aortic pressure gradient; MR, mitral regurgitation; MS, mitral stenosis; PCI, percutaneous coronary intervention; PG, pressure gradient; PROM, predicted risk of mortality; PWT, posterior wall thickness; STS, Society of Thoracic Surgeons; TR, tricuspid regurgitation; Vmax, peak aortic jet velocity.
Risk‐adjusting variables selected for the multivariable Cox proportional hazards models.
Anemia was defined by the World Health Organization criteria (hemoglobin <12.0 g/dL in women and <13.0 g/dL in men).