Ito et al reported prognostic factors for a patient with moderate aortic stenosis. These can help to identify a patient who may benefit from more aggressive management. The authors are from the Mayo Clinic in Rochester.
Patient selection: moderate aortic stenosis (aortic valve area from 1.01 to 1.50 square cm)
Prognostic factors:
(1) left ventricular ejection fraction (LVEF) < 50% (HR 3.0)
(2) stroke volume index (SVI) < 35 mL per square meter HR 3.3)
(3) elevated septal E/e' ratio (HR 2.7), defined as >= 14 without and >= 11 with atrial fibrillation or flutter
LVEF
SVI
Septal E/e'
5-Year Mortality
>= 50%
>= 35
normal
19%
>= 50%
>= 50%
elevated
47%
< 50%
< 35
NA
73%
LVEF
SVI
Septal E/e'
Risk Stratum
>= 50%
>= 35
normal
lower
>= 50%
>= 35
elevated
intermediate
< 50%
NA
NA
high
NA
< 35
NA
high
where:
• E is early transmitral filling peak velocity.
• e' was recorded on septal and mitral aspects.
A high risk patient still has a worse prognosis even after aortic valve replacement.
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