Clinical features and prognosis of patients with isolated severe aortic stenosis and valve area less than 1.0 cm2

Objective Current guidelines define severe aortic stenosis (AS) as an aortic valve area (AVA)<= 1.0 cm(2), but some authors have suggested that the AVA cut-off be decreased to 0.8 cm(2). The aim of this study was, therefore, to better describe the clinical features and prognosis of patients with an AVA of 0.8-0.99 cm(2). Methods Patients with isolated, severe AS and ejection fraction >= 55% with an AVA of 0.8-0.99 cm(2) (n=105) were compared with those with an AVA<0.8 cm(2) (n=155) and 1.0-1.3 cm(2) (n=81). The endpoint of this study was a combination of death from any cause or aortic valve replacement at or before 3 years. Results Patients with an AVA of 0.8-0.99 cm(2) group comprised predominantly normal-flow, low-gradient (NFLG) AS, while high gradients and low flow were more often observed with an AVA<0.8 cm(2). The frequency of symptoms was not significantly different between an AVA of 0.8-0.99 cm(2) and 1.0-1.3 cm(2). The combined endpoint was achieved in 71%, 52% and 21% of patients with an AVA of 0.8 cm(2), 0.8-0.99 cm(2) and 1.0-1.3 cm(2), respectively (p<0.001). Among patients with an AVA of 0.8-0.99 cm(2), NFLG AS was associated with a lower hazard (HR=0.40, 95% CI 0.23 to 0.68, p=0.001) of achieving the combined endpoint with outcomes similar to moderate AS in the first 1.5 years of follow-up. Patients with high-gradient or low-flow AS with an AVA of 0.8-0.99 cm(2) had outcomes similar to those with an AVA<0.8 cm(2). The sensitivity for the combined endpoint was 61% for an AVA cut-off of 0.8 cm(2) and 91% for a cut-off of 1.0 cm(2). Conclusions T he outcomes of patients with AS with an AVA of 0.8-0.99 cm(2) are variable and are more precisely defined by flow-gradient status. Our findings support the current AVA cut-off of 1.0 cm(2).