166 A risk score for predicting outcome in asymptomatic aortic stenosis

BackgroundThe management of patients with asymptomatic severe aortic stenosis remains controversial. We sought to develop a continuous risk score for predicting the mid-term development of symptoms or adverse events in this setting.Methods and ResultsWe prospectively followed 107 patients with asymptomatic aortic stenosis (aged 72 years [63-77]; 35 women; aortic-jet velocity, 4.1 m/s [3.5-4.4]) at a single center in France. Predefined endpoints for assessing outcome were the occurrence within 24 months of death or aortic valve replacement necessitated by symptoms or by a positive exercise test. Variables independently associated with outcome were used to build a score that was validated in an independent cohort of 107 patients from Belgium. Independent predictors of outcome were female gender, peak aortic jet velocity and B-Type Natriuretic Peptide (BNP) at baseline. Accordingly, the score could be calculated as: Score = [Peak velocity (m/s) x 2] + [natural logarithm of BNP x 1.5] + 1.5 (if female gender). Event-free survival after 20 months was 80% for patients within the first Score quartile, as compared to only 7% for the fourth quartile (Figure). Areas under the ROC curve for the score were 0.90 and 0.89 in the development and validation cohorts respectively.ConclusionsIf further validation is achieved, this score may be useful to predict outcome in individual patients with asymptomatic aortic stenosis in order to select those who might benefit from early surgery