Genereux et al reported a classification for staging cardiac damage associated with aortic stenosis. This can aid decisions about aortic valve replacement. The authors are from multiple institutions in the United States and Canada.
Patient selection: aortic stenosis
Sites of damage beyond the aortic valve:
(1) left ventricular damage (LVEF < 50%; hypertrophy; ratio E to e' > 14)
(2) left atrial damage (left atrial volume > 34 mL per square meter BSA)
(3) mitral valve damage (moderate or severe regurgitation)
(4) tricuspid valve damage (moderate or severe regurgitation)
(5) damage to pulmonary vasculature (systolic pressure >= 60 mm Hg)
(6) right ventricular damage (moderate or severe ventricular dysfunction)
where:
• Left ventricular hypertrophy associated with increased mass index: > 115 g per square meter BSA in males; > 95 g per square meter in females)
|
Site of Damage
|
Damage Stage
|
|
none
|
0
|
|
left ventricle
|
1
|
|
left atrium
|
2
|
|
mitral valve
|
2
|
|
tricuspid valve
|
3
|
|
pulmonary vasculature
|
3
|
|
right ventricle
|
4
|
stage of damage =
= MAX(damage stage)
|
Stage
|
1-Year Mortality
|
|
0
|
4.4%
|
|
1
|
9%
|
|
2
|
14%
|
|
3
|
21%
|
|
4
|
25%
|
The mortality associated with aortic valve replacement increased with each stage (hazard ratio 1.5 per stage). The damage stage and grade of aortic stenosis can help in the decision to perform surgery.
