Ratio of vena contracta width to aortic valve area index for risk stratification of patients with mixed aortic valvular disease

Abstract Background In patients with mixed aortic valve disease (MAVD), defined as the combination of aortic stenosis (AS) and aortic regurgitation (AR), the assessment of severity of each valve lesion is often challenging, as most echocardiographic parameters tend to be inaccurate in this setting. There is limited and contradictory data regarding which parameter should be used to risk stratify these patients. Aortic valve area (AVA) is considered a reliable marker of AS severity in the presence of AR, while vena contracta (VC) width provides an accurate estimation of AR severity in the presence of AS. Purpose To evaluate the prognostic value of combining VC and AVA index (AVAi) in asymptomatic patients with significant MAVD (≥ moderate AS and ≥ moderate AR) and left ventricular ejection fraction (LVEF) >50%. Methods A total of 601 patients (mean age 64±17 years, 54% male) with significant MAVD were included. Measurements of VC and AVAi were combined in the VC/AVAi ratio. The study endpoint was all-cause mortality. Aortic valve replacement (AVR) was accounted for during follow-up as a time-dependent covariate. ROC analysis was performed to identify the optimal threshold for predicting mortality, further assessed with restricted cubic spline analysis (Figure 1). Results Over a median follow-up of 7.3 years (IQR, 2.1-12.5), 183 patients (30%) died. The VC/AVAi threshold associated with mortality was ≥10 (Figure 1). Patients with VC/AVAi ≥10 were older (66±16 vs. 60±18 years, p