Comparison of demographics, cardiovascular risk factors profile and prevalence of coexistent atherosclerotic vascular disease in patients with severe aortic stenosis stratified according to dichotomized stenosis severity

Introduction

Degenerative calcific aortic stenosis (AS) is the most frequent valvular heart disease in Europe and North America. The prevalence of this AS form is especially pronounced in the elderly, representing a major public health issue [1–5]. The choice of optimal management of AS patients requires appropriate identification of subjects with severe AS, and echocardiography is a first-line method to diagnose AS and estimate its severity [5]. According to clinical practice guidelines, echocardiographic criteria of severe AS include a calculated aortic valve area (AVA) < 1.0 cm2, mean transaortic valve pressure gradient > 40 mm Hg or maximal flow velocity > 4 m/s [5]. Inconsistencies in AS grading were confirmed by cardiac catheterization and a calculated AVA of 0.8 cm2 corresponded to a mean transvalvular pressure gradient of 40 mm Hg by echocardiography in patients with severe AS and a normal left ventricular stroke volume [6].

Aim

Our aim was to compare clinical characteristics of patients with severe degenerative AS according to the degree of AVA narrowing categorized by an AVA cut-off value of 0.8 cm2.

Material and methods

We retrospectively analyzed data of 145 previously described [7] consecutive patients (66 women and 79 men) with severe degenerative AS who were admitted to our tertiary center between January 2003 and October 2012. The diagnosis of severe AS was based on recognized echocardiographic criteria [5]. All examinations were performed by one of two well-experienced sonographers with the highest level of competence in our department. All patients underwent elective coronary angiography and carotid ultrasonography as a part of routine diagnostic work-up. Patients’ characteristics obtained during the index hospitalization were recorded. The ethics committee of our university was notified about the registry and no objection was raised. A detailed study design was published previously, as well as results of a data analysis primarily focused on the determinants of coexistent coronary and carotid atherosclerosis [7].
Cardiovascular risk factors (arterial hypertension, hypercholesterolemia, diabetes mellitus and self-reported current smoking habit) were defined according to current recommendations as reported previously [7]. Estimated glomerular filtration rate (eGFR) was calculated according to the simplified Modification of Diet in Renal Disease Study formula. Significant coronary artery disease (CAD)...


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