Table 1

Prospective studies assessing risk stratification in moderate-to-severe asymptomatic AS

AuthorNSeverityCADOutcomeFollow-up: monthsAVRTotal/cardiac deathsSCDOutcome predictor
Rosenhek et al10128Severe (>4 m/s)Not excludeDeath, AVR22±1859 of 106 (56%)8
6 cardiac
1 (0.9%)Calcification, rapid progression
Amato et al1366Severe (AVA <1 cm2)Excluded (angio)Death, symptoms15±12?3444 (6.1%)AVA <0.7 cm2, positive ETT
Lancellotti et al1469Severe (AVA <1 cm2)Not excludedSymptoms, death, AVR15±712 (17%)3 cardiac + 1 death post-AVR2 (2.9%) SCDExercise mean PG +ve ETT, AVA <0.75 cm2
Das et al15125Moderate-to–severe (AVA <1.4 cm2),Not excludedSymptoms, death1236 (29%) symptoms? AVRNo deathsNo SCDExercise symptoms
Monin et al40104Moderate-to-severe: >3 m/s AVA <1.5 cmRWMA excludeIndication for AVR, death2458 AVR4 deaths (1 post-AVR)Female sex, BNP, peak velocity
Rosenhek et al12116Very severe >5 m/sNot excludedIndication for AVR, death41 (median)79 AVR, 10 refused AVR17 deaths
9 no surgery
8 post-AVR
1 SCDPeak AV >5.5 m/s, diabetes, cholesterol
Kang et al11197Very severe >4.5 m/s or AVA <0.75 cm2History or RWMADeath42 AVR
58 medical
148
102 early,
46 (of 95)
medical
3 (0 cardiac) early, 28 (12 cardiac) medical9 (10%)
medical
0 early
Peak AV >5 m/s
Cioffi et al20209Severe (AVA<1 cm2 or mean PG>40 mm HgHistoryDeath, AVR, MI, HF hospitalisation22±137220 (16 cardiac)2 SCDInappropriate high LVMI, peak velocity, calcification
  • Source: Adapted from ref. 9-reproduced with permission.

  • Angio, coronary angiography; AS, aortic stenosis; AV, aortic valve velocity; AVA, aortic valve area; AVR, aortic valve replacement; BNP, brain natriuretic peptide; CAD, coronary artery disease; ETT, exercise tolerance test; HF, heart failure; LVMI, left ventricular mass index; MI, myocardial infarction; PG, pressure gradient; RWMA, regional wall motion abnormalities; SCD, sudden cardiac death.