Discordant Grading of Aortic Stenosis Severity
Open accessAbstract
Objectives This study sought to assess the survival benefit associated with aortic valve replacement (AVR) according to different strata of echocardiographic parameters of aortic stenosis (AS) severity, and especially in patients with an aortic valve area (AVA) comprised between 0.8 cm(2) and 1 cm(2).Background Discordant findings between AVA (≤1.0 cm(2)) and mean gradient (MG) (<40 mm Hg) raise uncertainty regarding the actual severity of AS. Some studies suggested that the AVA threshold value to define severe AS should be decreased to 0.8 cm(2) to reconcile these discordances.Methods A total of 1,710 patients with documented moderate to severe AS by Doppler echocardiography were separated into 4 strata of AS severity based alternatively on AVA, indexed AVA, MG, or peak aortic jet velocity (Vpeak). We compared the survival rates of medically versus surgically treated patients. To eliminate covariate differences that may lead to biased estimates of treatment effect, a propensity matching with a greedy 5-to-1 digit-matching algorithm was used.Results Mean AVA was 0.9 ± 0.3 cm(2), mean MG 33 ± 18 mm Hg, and mean Vpeak 3.6 ± 0.9 m/s. A total of 1,030 (60%) patients underwent AVR within 3 months following echocardiographic evaluation. During a mean follow-up of 4.4 ± 3.0 years there were 469 deaths. Patients with an AVA between 0.8 cm(2) and 1.0 cm(2) had a significant observed survival benefit with AVR (hazard ratio: 0.37 [95% confidence interval: 0.21 to 0.63]; p = 0.0002). AVR was also associated with improved survival in patients with MG between 25 mm Hg and 40 mm Hg or Vpeak between 3 m/s and 4 m/s, but only in patients with concomitant AVA ≤1 cm(2) (p = 0.001 vs. p = 0.46 in patients with AVA >1 cm(2)).Conclusions These results do not support decreasing the AVA threshold value for severity to 0.8 cm(2) and they confirm that AVR is associated with improved survival in a substantial number of patients with discordant aortic grading.
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One third of patients with a severe aortic stenosis on the basis of aortic valve area (<1.0 cm2) present with a low gradient (<40 mm Hg) suggestive of nonsevere aortic stenosis.
“However, one third of patients with a “severe AS” on the basis of the AVA (<1.0 cm2) present with a low gradient (<40 mm Hg) suggestive of nonsevere AS. 22 , 23 , 24”
From Grading of Aortic Valve Calcification Severity and Risk Stratification in Aortic Stenosis (2024) · cites this paper as [24]
The Abstract describes discordant grading—valve area ≤1 cm² with a gradient <40 mm Hg—as a common pattern. The Conclusions report discordance in 30% of patients with moderate-to-severe aortic stenosis and normal ejection fraction and flow, but define it using a low gradient or low peak velocity. That does not establish that one third of all patients classified as severe by valve area have a gradient <40 mm Hg. (LLM, conf=0.84)
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References 33 · Cited by 92
- Authors
- Berthelot-Richer, M., Pibarot, P., Capoulade, R., Dumesnil, J. G., Dahou, A., Thebault, C., Le Ven, F., & Clavel, M.-A.
- Affiliations
- Institut universitaire de cardiologie et de pneumologie de Québec (CA)
- Corresponding author
- Clavel, Marie-Annick
- Venue
- JACC: Cardiovascular Imaging
- Publisher
- Elsevier BV
- Published
- 2016-07
- Volume
- 9
- Issue
- 7
- Pages
- 797-805
- ISSN
- 1876-7591 (ISSN-L)
- 1936-878X
- OpenAlex
- W2396828285
- Cited by
- 92
- References
- 33
- Citations by year
- 2026: 8 · 2025: 4 · 2024: 8 · 2023: 7 · 2022: 6 · 2021: 14 · 2020: 9 · 2019: 12 · 2018: 5 · 2017: 15 · 2016: 4
- FWCI
- 9.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC. Cardiovascular imaging (publishedVersion)
- PubMed (publishedVersion)
- Corpus Université Laval (Université Laval) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Keywords
- aortic stenosis, aortic valve replacement, aortic valve area, mean gradient, survival benefit, medical management, propensity score matching, Doppler echocardiography, surgical versus medical treatment, mortality risk stratification, propensity score stratification
- MeSH terms
- Aged, Aged, 80 and over, Algorithms, Aortic Valve, Aortic Valve Stenosis, Female, Hemodynamics, Humans, Male, Middle Aged, Predictive Value of Tests, Retrospective Studies, Risk Factors, Severity of Illness Index, Time Factors, Echocardiography, Doppler, Multivariate Analysis, Chi-Square Distribution, Proportional Hazards Models, Treatment Outcome, Risk Assessment, Blood Vessel Prosthesis Implantation, Kaplan-Meier Estimate, Propensity Score
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