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Background: Severe aortic stenosis is defined by a peak velocity > 4 m/s and an aortic valve area (AVA) < 1.0cm2 (AHH/ACC-Guidelines 2006). Adjusting of AVA by body surface area (AVA index) has been advocated to reduce body size dependency with a cut-off value of < 0.6 cm2/m2 for severe aortic stenosis. However, the usefulness of this approach has never been proven in a large patient population. AVA index compared to AVA should reduce the number of patients with criteria for severe aortic stenosis in small individuals and increase the number in large ones.Methods: Echocardiographic and anthropometric data were analysed in 2913 consecutive patients with all grades of aortic valve stenosis (peak velocity > 2.5m/s) and normal left ventricular function.Results: Mean body surface area was 1.89±0.21m2. Criteria for severe aortic stenosis were fulfilled in 55% of patients according to peak velocity, and in 70% according to AVA. Indexing by body surface area further increased the percentage of patients with severe stenosis to 79%. Patients were divided into quartiles according to body surface area. Results are presented in table 1. In small patients indexing did not change the percentage of patients with criteria for severe stenosis whereas it markedly increased the percentage in large patients.Conclusion: Applying the current cut-off value of 0.6cm2/m2, indexing of AVA by body surface area markedly increases the overall number of patients fulfilling the criteria for severe aortic stenosis.