Abstract/Details

Early identification of symptomatic aortic stenosis using echocardiographic data


2011 2011

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Abstract (summary)

Background: Heart failure (CHF) is the most frequent and prognostically severe symptom of aortic stenosis (AS), and the most common indication for surgery. The mainstay of treatment for AS is aortic valve replacement (AVR), and the main indication for an AVR is development of symptomatic disease. ACC/AHA guidelines define severe AS as an aortic valve area (AVA) ≤1cm², but there is little data correlating echocardiogram AVA with the onset of symptomatic CHF. We evaluated the risk of developing CHF with progressively decreasing echocardiographic AVA. We also compared echocardiographic AVA with Jet velocity (V2) and indexed AVA (AVAI) to assess the best predictor of development of symptomatic CHF.

Methods and Results: This retrospective cohort study evaluated 518 patients with asymptomatic moderate or severe AS from a single community based cardiology practice. A total of 925 echocardiograms were performed over an 11-year period. Each echocardiogram was correlated with concurrent clinical assessments while the investigator was blinded to the echocardiogram severity of AS. The Cox Proportional hazards model was used to analyze the relationship between AVA and the development of CHF. The median age of patients at entry was 76.1 years, with 54% males. A total of 116 patients (21.8%) developed new onset CHF during follow-up. Compared to patients with AVA >1.0cm², patients with lower AVA had an exponentially increasing risk of developing CHF for each 0.2cm² decrement in AVA, becoming statistically significant only at an AVA less than 0.8 cm². Also, compared to V2 and AVAI, AVA added more information to assessing risk for development of CHF (p=0.041).

Conclusion: In patients with normal or mildly impaired LVEF, the risk of CHF rises exponentially with decreasing valve area and becomes statistically significant after AVA falls below 0.8cm². AVA is a better predictor of CHF when compared to V2 or AVAI.

Indexing (details)


Subject
Medicine;
Epidemiology
Classification
0564: Medicine
0766: Epidemiology
Identifier / keyword
Health and environmental sciences; Aortic stenosis; Echocardiography; Heart failure
Title
Early identification of symptomatic aortic stenosis using echocardiographic data
Author
Sharma, Parikshit S.
Number of pages
21
Publication year
2011
Degree date
2011
School code
0219
Source
MAI 50/01M, Masters Abstracts International
Place of publication
Ann Arbor
Country of publication
United States
ISBN
9781124811987
Advisor
Ford, Charles E.; Baraniuk, Mary Sarah.
Committee member
BARANIUK, MARY S.; FORD, CHARLES E.
University/institution
The University of Texas School of Public Health
Department
Epidemiology & Disease Control
University location
United States -- Texas
Degree
M.P.H.
Source type
Dissertations & Theses
Language
English
Document type
Dissertation/Thesis
Dissertation/thesis number
1497478
ProQuest document ID
886443924
Copyright
Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works.
Document URL
http://search.proquest.com/docview/886443924
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