Abstract 9878: Small Aortic Roots - Clinical Characteristics and Implications for Assessment of Aortic Stenosis in Asymptomatic Patients With Preserved Ejection Fraction

Background: The aim was to characterize asymptomatic aortic stenosis (AS) patients with small aortic roots and the implications for assessment of AS severity. Methods: We analysed data from 1563 patients with asymptomatic AS enrolled in the Simvastatin Ezetimibe in Aortic Stenosis study. Severe AS was defined by aortic valve area (AVA) as <1.0cm 2 , by AVA indexed for body surface area (AVAI) as <0.6cm 2 /m 2 and by energy loss index (ELI) as <0.6cm 2 /m 2 . Inconsistently graded severe AS was defined as the combination of AVA or ELI <1.0 cm 2 and mean aortic gradient ≤40mmHg. Results: A small aortic root (lowest tertile of aortic sinotubular junction diameter, <2.60cm) was present in 32.6% of patients. This group included more women (67.8% vs. 25.0%) and patients with hypertension and patients had smaller body surface area, height and left ventricular (LV) dimensions and higher age and pulse pressure/stroke volume index (PP/SVi) compared to the rest of the study population (all p<0.001). AS severity measured by peak jet velocity or mean gradient did not differ between groups. The prevalence of inconsistently graded severe AS was more common in patients with small aortic roots when using AVA (38.3 vs. 23.5%, p<0.001), but not when using ELI (23.8 vs. 24.0%, p=0.920). In multivariate logistic regression, having small aortic root was associated with a higher prevalence of inconsistently graded severe AS using AVA, independent of female gender, higher PP/SVi and lower height and smaller LV dimensions and wall thickness (Table). Conclusion: In asymptomatic AS the use of ELI for grading of AS rather than AVA lowered the prevalence of inconsistently graded severe AS among patients with small aortic roots. However inconsistently graded severe AS remained common using the currently recommended cut-off values for grading of AS. Table. Covariates of small aortic root in multivariate analysis.