• Chieh-Ju Chao, Pradyumma Agasthi, Marlene Girardo, Timothy Barry, Amith R Seri, Lisa Brown, Rachel E Wraith, Anusha Shanbhag, Yuxiang Wang, Yi-Chieh Chen, Steven J Lester, Said Alsidawi, William K Freeman, Tasneem Z Naqvi, Mackram Eleid, David Fortuin, Peter Pollak, Abdallah El Sabbagh, Kristen Sell-Dottin, David Majdalany, Carolyn Larsen, David R Holmes, Jae K Oh, Christopher P Appleton, and Reza Arsanjani.
• Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, AZ; Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN. Electronic address: chao.chiehju@mayo.edu.
• Mayo Clin. Proc. 2023 Oct 1; 98 (10): 150115141501-1514.

ObjectiveTo study the usefulness of a novel echocardiographic marker, augmented mean arterial pressure (AugMAP = [(mean aortic valve gradient + systolic blood pressure) + (2 × diastolic blood pressure)] / 3), in identifying high-risk patients with moderate aortic stenosis (AS).Patients And MethodsAdults with moderate AS (aortic valve area, 1.0-1.5 cm2) at Mayo Clinic sites from January 1, 2010, through December 31, 2020, were identified. Baseline demographic, echocardiographic, and all-cause mortality data were retrieved. Patients were grouped into higher and lower AugMAP groups using a cutoff value of 80 mm Hg for analysis. Kaplan-Meier and Cox regression models were used to assess the performance of AugMAP.ResultsA total of 4563 patients with moderate AS were included (mean ± SD age, 73.7±12.5 years; 60.5% men). Median follow-up was 2.5 years; 36.0% of patients died. The mean ± SD left ventricular ejection fraction (LVEF) was 60.1%±11.4%, and the mean ± SD AugMAP was 99.1±13.1 mm Hg. Patients in the lower AugMAP group, with either preserved or reduced LVEF, had significantly worse survival performance (all P<.001). Multivariate Cox regression showed that AugMAP (hazard ratio, 0.962; 95% CI, 0.942 to 0.981 per 5-mm Hg increase; P<.001) and AugMAP less than 80 mm Hg (hazard ratio, 1.477; 95% CI, 1.241 to 1.756; P<.001) were independently associated with all-cause mortality.ConclusionAugMAP is a simple and effective echocardiographic marker to identify high-risk patients with moderate AS independent of LVEF. It can potentially be used in the candidate selection process if moderate AS becomes indicated for aortic valve intervention in the future.Copyright © 2023 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

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