Prognostic Risk Stratification of Patients with Moderate Aortic Stenosis

Saki Ito, William R. Miranda, Vuyisile T. Nkomo, Amber N. Boler, Sorin V. Pislaru, Patricia A. Pellikka, Daniel J. Crusan, Bradley R. Lewis, Rick A. Nishimura, Jae K. Oh

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Currently risk stratification of moderate aortic stenosis (AS) is still incipient. The aim of this study was to identify prognostic factors in patients with moderate AS. Methods: The prognosis of patients with moderate AS (1 < aortic valve area ≤ 1.5 cm2) stratified by left ventricular ejection fraction (LVEF; 50%), stroke volume index (SVI; 35 mL/m2), and elevated E/e′ ratio (average, 14) was compared with that of the age- and sex-matched general population. Results: Of 696 patients (median age, 77 years; aortic valve area 1.3 cm2; 57% men), 279 (40%) died during a median follow-up period of 3.4 years. Mortality was higher in patients with moderate AS than reference (mortality ratio, 2.43; 95% CI, 2.17–2.72). LVEF < 50%, SVI < 35 mL/m2, and elevated E/e′ ratio were present in 113 (17%), 54 (8%), and 330 (54%) patients; mortality ratios were 3.89 (95% CI, 3.07–4.85), 6.40 (95% CI, 4.57–8.71), and 2.58 (95% CI, 2.21–3.00), respectively. Even if LVEF or SVI was preserved, the mortality ratio was more than twice than reference (P < .001), but elevated E/e′ ratio could discriminate additional patients at higher risk (hazard ratio [HR], 2.71; 95% CI, 1.88–3.91). Two hundred one patients (29%) underwent aortic valve replacement at a median of 2.3 years after the diagnosis of moderate AS. LVEF < 50% (HR, 2.98; 95% CI, 1.39–6.56), SVI < 35 mL/m2 (HR, 3.34; 95% CI, 1.02–10.90) and elevated E/e′ ratio (HR, 2.73; 95% CI, 1.26–5.94) were all associated with worse prognosis even if aortic valve replacement was performed. Conclusions: In patients with moderate AS, those with decreased LVEF and/or SVI are at high risk. Even if these parameters are preserved, patients with elevated E/e′ ratios are at intermediate risk. Further investigation is warranted to assess whether earlier intervention could improve outcomes and reduced cardiac-related death among patients at high and intermediate risk.

Original languageEnglish (US)
Pages (from-to)248-256
Number of pages9
JournalJournal of the American Society of Echocardiography
Issue number3
StatePublished - Mar 2021


  • Diastology
  • LVEF
  • Moderate AS
  • Natural history
  • Stroke volume

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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