Prognostic value of area of calcified aortic valve by 2-dimensional echocardiography in asymptomatic severe aortic stenosis patients with preserved left ventricular ejection fraction

We hypothesized that area of calcified aortic valve (ACAV) measured by 2D echocardiography (2DE) can predict future cardiovascular events in asymptomatic severe aortic stenosis (AS). Multidetector computed tomography determined aortic valve calcification load is strongly associated with AS severity but has risks for radiation exposure. Quantification of ACAV by transthoracic 2DE is simple and convenient but its clinical utility has not been extensively studied. We measured ACAV in 124 asymptomatic severe AS patients (80±9 years, 45 males) with preserved left ventricular ejection fraction. ACAV was measured by planimetry from 2D zoomed long axis view of the AV at end-diastole. Patients were followed to record cardiac death (CD) and major adverse cardiovascular events (MACEs). During a median follow-up of 232 days, 17 patients had MACE, including 8 CD. ACAV was significantly larger in patients with event compared to those without (1.14±0.35cm 2 vs 0.87±0.34cm 2, P=.0032). Using receiver operating characteristics derived ACAV of 0.79cm 2 as cutoff value, Kaplan-Meyer analysis showed it could discriminate high-risk group from low-risk group for future CD (P=.0223, χ 2 =5.22) and MACE (P=.0054, χ 2 =7.74). 2DE determined ACAV is straightforward and has potential to predict future cardiac events in asymptomatic severe AS patients.