0085: Risk stratification in severe aortic stenosis: the importance of ventriculo-arterial interplay

Introduction in patients with aortic stenosis (AS), the occurrence of adverse outcomes does not always correspond to the classical markers of haemodynamic severity. Moreover, the evaluation of outcomes in these patients is often biased by considering surgery as a censor event at follow-up analysis. Aim of the present study is therefore to evaluate the determinants of prognosis in patients with severe AS, independently from the treatment modality (aortic valve replacement/medical therapy). Methods 220 patients (mean age: 79.8±8.6 years, male sex: 119, 54%) with severe AS (aortic valve surface <1cm2 or <0.6cm2/m2) underwent standard echocardiography to characterize aortic valve gradients and biventricular function. Hospitalization for cardiac cause, heart failure, overall death, but not intervention on the aortic valve were considered as major adverse cardiac events (MACEs). Results after a mean follow-up period of 7.8 months, the predefined MACEs occurred in 57 patients (26%). At Cox regression analysis, LVESV (HR 1.20, p=0.0025), age (HR 0.79, p=0.03), female sex (HR 1.43, P=0.05) and a Zva>3.2 mmHg/ ml/m2 (HR 3.53, p<0.0001) were the strongest predictors of events. Conclusions In patients with severe AS, a ZVa >3.2 mmHg/ ml/m2 is the strongest predictor of prognosis, independently from the treatment modality. The ventriculo-arterial interplay has thus a fundamental role in AS, defining the natural history of the disease and suggesting that a careful reduction of LV afterload could be very useful in the clinical management of these patients.