Classification of severe aortic stenosis and outcomes after aortic valve replacement

Yura Ahn; Se Jin Choi; Soyeoun Lim; Joon Bum Kim; Jong-Min Song; Duk-Hyun Kang; Jae-Kwan Song; Hwa Jung Kim; Joon-Won Kang; Dong Hyun Yang; Dae-Hee Kim; Hyun Jung Koo

doi:10.1038/s41598-022-11491-3

Classification of severe aortic stenosis and outcomes after aortic valve replacement

Sci Rep. 2022 May 7;12(1):7506. doi: 10.1038/s41598-022-11491-3.

Authors

Yura Ahn^#¹, Se Jin Choi^#¹, Soyeoun Lim², Joon Bum Kim³, Jong-Min Song⁴, Duk-Hyun Kang⁴, Jae-Kwan Song⁴, Hwa Jung Kim⁵, Joon-Won Kang¹, Dong Hyun Yang¹, Dae-Hee Kim⁶, Hyun Jung Koo⁷

Affiliations

¹ Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro, 388-1, Seoul, 05505, South Korea.
² Department of Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
³ Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁴ Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro, 388-1, Seoul, 05505, South Korea.
⁵ Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
⁶ Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro, 388-1, Seoul, 05505, South Korea. daehee74@amc.seoul.kr.
⁷ Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro, 388-1, Seoul, 05505, South Korea. radkoo@amc.seoul.kr.

^# Contributed equally.

Abstract

Aortic valve calcium scoring by cardiac computed tomographic (CT) has been recommended as an alternative to classify the AS (aortic stenosis) severity, but it is unclear that whether CT findings would have additional value to discriminate significant AS subtypes including high gradient severe AS, classic low-flow, low gradient (LF-LG) AS, paradoxical LF-LG AS, and moderate AS. In this study, we examined the preoperative clinical and cardiac CT findings of different subtypes of AS in patients with surgical aortic valve replacement (AVR) and evaluated the subtype classification as a factor affecting post-surgical outcomes. This study included 511 (66.9 ± 8.8 years, 55% men) consecutive patients with severe AS who underwent surgical AVR. Aortic valve area (AVA) was obtained by echocardiography (AVA_echo) and by CT (AVA_CT) using each modalities measurement of the left ventricular outflow tract. Patients with AS were classified as (1) high-gradient severe (n = 438), (2) classic LF-LG (n = 18), and (3) paradoxical LF-LG (n = 55) based on echocardiography. In all patients, 455 (89.0%) patients were categorized as severe AS according to the AVA_CT. However, 56 patients were re-classified as moderate AS (43 [9.8%] high-gradient severe AS, 5 [27.8%] classic LF-LG AS, and 8 [14.5%] paradoxical LF-LG AS) by AVA_CT. The classic LF-LG AS group presented larger AVA_CT and aortic annulus than those in high-gradient severe AS group and one third of them had AVA_CT ≥ 1.2 cm². After multivariable adjustment, old age (hazard ratio [HR], 1.04, P = 0.049), high B-type natriuretic peptide (BNP) (HR, 1.005; P < 0.001), preoperative atrial fibrillation (HR, 2.75; P = 0.003), classic LF-LG AS (HR, 5.53, P = 0.004), and small aortic annulus on CT (HR, 0.57; P = 0.002) were independently associated with major adverse cardiac and cerebrovascular events (MACCE) after surgical AVR.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aortic Valve / diagnostic imaging
Aortic Valve / surgery
Aortic Valve Stenosis* / diagnostic imaging
Aortic Valve Stenosis* / etiology
Aortic Valve Stenosis* / surgery
Female
Heart Valve Prosthesis Implantation* / methods
Heart Valve Prosthesis*
Humans
Male
Severity of Illness Index
Stroke Volume
Treatment Outcome