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Adjusting parameters of aortic valve stenosis severity by body size
Journal
Heart
Volume
100
Number
13
Pages / Article-Number
1024-30
Keywords
Adult; Aged; Aged, 80 and over; Aortic Valve/diagnostic imaging/*physiopathology; Aortic Valve Stenosis/*diagnosis/mortality/physiopathology/therapy; Body Height; Body Mass Index; *Body Size; Body Surface Area; Body Weight; Echocardiography, Doppler; Female; *Hemodynamics; Humans; Male; Middle Aged; Nonlinear Dynamics; Predictive Value of Tests; Prospective Studies; Randomized Controlled Trials as Topic; Retrospective Studies; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome; Young Adult
Mesh terms
Adult; Aged; Aged, 80 and over; Aortic Valve, physiopathology; Aortic Valve Stenosis, therapy; Body Height; Body Mass Index; Body Size; Body Surface Area; Body Weight; Echocardiography, Doppler; Female; Hemodynamics; Humans; Male; Middle Aged; Nonlinear Dynamics; Predictive Value of Tests; Prospective Studies; Randomized Controlled Trials as Topic; Retrospective Studies; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome; Young Adult
Abstract
BACKGROUND: Adjustment of cardiac dimensions by measures of body size appears intuitively convincing and in patients with aortic stenosis, aortic valve area (AVA) is commonly adjusted by body surface area (BSA). However, there is little evidence to support such an approach. OBJECTIVE: To identify the adequate measure of body size for the adjustment of aortic stenosis severity. METHODS: Parameters of aortic stenosis severity (jet velocity, mean pressure gradient (MPG) and AVA) and measures of body size (height, weight, BSA and body mass index (BMI)) were analysed in 2843 consecutive patients with aortic stenosis (jet velocity 0.001) to the effect that larger patients presented with larger AVA (less severe stenosis). Of the anthropometric measures used for linear adjustment, BSA was most effective in eliminating the correlation between AVA and body size (r=0.007), rivalled only by allometric (non-linear) models, findings that are confirmed in 1525 prospectively followed patients from the SEAS study. Predictive accuracy for aortic valve events and cardiovascular death during 46 months of follow-up was unchanged by adjusting AVA, regardless of measure of body size (area under the receiver operating curve for AVA 0.72 (CI 0.58 to 0.87) versus, for example, AVA/BSA 0.75 (CI 0.61 to 0.88), p=0.22). CONCLUSIONS: In the assessment of aortic stenosis, linear adjustment of AVA by BSA improves comparability between patients with diverging body size without, however, increasing the predictive accuracy for clinical events in a population with mild to moderate stenosis.
