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Risk Score of Monin et al for Predicting Outcome for a Patient with Asymptomatic Aortic Stenosis

Purpose: To evaluate a patient with asymptomatic aortic stenosis using the risk score of Monin et al.

Description

Monin et al developed a score for predicting the risk of adverse outcomes in a patient with asymptomatic aortic stenosis. This can help to identify a patient who may benefit from more aggressive management. The authors are from Henri Mondor University Hospital in Creteil (France), Institut Jacques Cartier in Massy (France), and Sart Tilman University in Liege (Belgium).


Patient selection: asymptomatic adult with moderate to severe aortic stenosis, normal sinus rhythm, normal renal function, normal left ventricular function, absence of significant disease in other valves

 

Outcome: positive exercise stress test, need for valve replacement, death

 

Parameters at presentation:

(1) gender

(2) serum BNP in pg/mL (Biosite)

(3) peak aortic velocity in meters per second on Doppler echocardiography

 

score =

= (2 * (peak velocity)) + (1.5 * LN(BNP)) + (1.5 if female, 0 if male)

 

Interpretation:

• In Figure 3 the score ranges from 7 to 23.

• The higher the score the greater the risk of the adverse outcome.

 

Total Score

Risk Group at 24 Months

< 11

low (< 10%)

11 to 13

low to intermediate

13 to 16

intermediate to high

> 16

high risk (> 75%)

 

Limitations:

• The maximum value is dependent on the BNP assay. The maximum value in the study was 165 pg/mL. An alternative method would affect performance.


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Specialty

Objective

ICD-10