Risk Stratification of Severe Aortic Stenosis With Preserved Left Ventricular Ejection Fraction Using Peak Aortic Jet Velocity

Management of asymptomatic patients with severe aortic stenosis (AS) is subject to debate. A watchful waiting strategy is adopted for the vast majority of asymptomatic patients because the surgical risk exceeds the spontaneous risk. However, a subset of patients with asymptomatic severe AS might benefit from early surgery. Only 1 study reported that asymptomatic patients with very severe AS (VSAS) incur high risk of adverse events (composite end point of aortic valve replacement [AVR] and death). Current guidelines consider that elective AVR is reasonable in asymptomatic patients with VSAS when the surgical risk is low (class IIa recommendation). However, the definition of VSAS is also debated. US guidelines define VSAS as peak aortic jet velocity (Vmax) ≥5 m/s, whereas the European guidelines refer to Vmax >5.5 m/s as cutoff for VSAS. Accordingly, the management of asymptomatic patients with Vmax between 5 and 5.5 m/s, representing in our experience 22% of patients with severe AS and preserved left ventricular ejection fraction (LVEF) remains controversial and needs clarification. Hence, it is essential to determine a Vmax cutoff associated with increased mortality risk.