LAUSR

Geoff Strange1, Simon Stewart2, David Celermajer3, Tom Marwick4, Greg Scalia5, David Prior6, Marcus Ilton7, David Playford1. 1University of Notre Dame, Fremantle, Australia; 2University of Adelaide, Adelaide, Australia; 3University of Sydney, Sydney, Australia; 4Baker IDI, Melbourne, Australia; 5University of Queensland, Queensland, Australia; 6University of Melbourne, Melbourne, Australia; 7Royal Darwin Hospital, Darwin, Australia Background: Echocardiography (echo) is pivotal in evaluation of aortic valve gradients. We evaluated prognostic implications of the full spectrum of aortic stenosis severity in a large patient cohort, matched with mortality data. Methods: NEDA is a vendor-agnostic cloud-based database, containing echo measurement data (1997 -2017) from laboratories (N=10) across Australia (currently >530,000 Echos). Data linkage to the National Death Index (NDI) provided survival status on each induvial from the last recorded echo to a census date in October 2017. Data were available from 352,844 individuals comprising 186,820 men (60.8±18.0 yrs) and 166,024 women (60.9±19.2 yrs) with a mean follow up of 5.4 years per person and 63,142 fatal events. Results: Overall, a peak aortic valve velocity (AVvel) was recorded in 278,955 patients, demonstrating a J-shaped mortality pattern with highest ageand sex-adjusted risk profi le in those individuals (n=52,010) in the upper quintile (> 1.8 m/s and mean aortic gradient of 13mmHg); HR=1.29 (95% CI 1.25-1.32, p<0.001) relative to the lowest quintile. 1and 5-year mortality was 5.0% and 14.9% in the lowest vs 9.2 and 28.1% in the highest (p<0.0001) quintile, respectively. Th ose cases in the upper quintile were then further examined for survival against increasing gradients (n=44,340). Aft er adjusting for age, gender and ejection fraction, the mortality risk plateaued at a threshold of a mean gradient ≥30.9±1.3mmHg (AVvel > 3.71±0.26m/s), with an adjusted HR=0.94(95% CI 0.82-1.08, p=0.4) compared with those in the upper quintile of that group (mean gradient 59.9±9.4mmHg, AVvel 4.96±0.47m/s). 1and 5-year mortality profi les were equivalent for those with mean aortic pressure gradients 20-30mmHg (10.9%, 32.6% respectively), 30-40mmHg (11.8%, 33.0%) and >40mmHg (13.7%, 34.5%). Conclusion: Aortic stenosis is associated with signifi cant mortality across the spectrum of severity, including mild disease. Th ere is no discernible diff erence in survival between “moderate” and “severe” aortic stenosis. P1-115