Small aortic root in aortic valve stenosis: clinical characteristics and prognostic implications.

Abstract

AIMS:

In aortic valve stenosis (AS), having a small aortic root may influence both the assessment of AS severity and the treatment strategy. The aim was to test the prognostic implications of having a small aortic root in AS within a large prospective study.

METHODS AND RESULTS:

We used data from 4.3-year follow-up of 1560 patients with asymptomatic, initially mostly moderate AS enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study. A small aortic root was defined as inner aortic sinotubular junction diameter indexed for body height <1.4 cm/m in women and <1.5 cm/m in men. A small aortic root was found in 270 patients (17.3%) at baseline. Having a small aortic root was associated with larger aortic root wall thickness, higher pressure recovery, lower systemic arterial compliance, left ventricular mass index, and female sex in a multivariable logistic regression analysis (all P < 0.05). In the Cox regression analysis, having a small aortic root at baseline was associated with higher hazard rates of ischaemic cardiovascular events (n = 268; HR 1.55, 95% CI 1.16-2.06), non-haemorrhagic stroke (n = 55; HR 1.88, 95% CI 1.04-3.41), and cardiovascular death (n = 81; HR 2.08, 95% CI 1.28-3.39) (all P < 0.05) after adjusting for confounders, including randomized study treatment, sex, hypertension, AS severity, and aortic valve replacement.

CONCLUSION:

In AS patients without known cardiovascular disease or diabetes, having a small aortic root was associated with increased ischaemic cardiovascular events and mortality. The results suggest a relation between the presence of a small aortic root and that of subclinical atherosclerosis.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov identifier: NCT00092677.

• Authors: Edda Bahlmann, Dana Cramariuc, Jan Minners, Mai Tone Lønnebakken, Simon Ray, Christa Gohlke-Baerwolf, Christoph A Nienaber, Nikolaus Jander, Reinhard Seifert, John B Chambers, Karl Heinz Kuck, Eva Gerdts
• Journal: European heart journal. Cardiovascular Imaging (Eur Heart J Cardiovasc Imaging) Vol. 18 Issue 4 Pg. 404-412 (Apr 01 2017) ISSN: 2047-2412 [Electronic] England
• PMID: 27491438 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: [email protected].

Chemical References

• Simvastatin
• Ezetimibe

Topics

• Aged
• Aortic Valve (diagnostic imaging, drug effects)
• Aortic Valve Stenosis (diagnostic imaging, drug therapy, mortality, physiopathology)
• Echocardiography
• Ezetimibe (therapeutic use)
• Female
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Predictive Value of Tests
• Proportional Hazards Models
• Prospective Studies
• Risk Assessment
• Severity of Illness Index
• Simvastatin (therapeutic use)
• Survival Rate
• Time Factors
• Treatment Outcome