Outcome of 622 Adults With Asymptomatic, Hemodynamically Significant Aortic Stenosis During Prolonged Follow-Up
Top Cited Papers
- 21 June 2005
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 111 (24), 3290-3295
- https://doi.org/10.1161/circulationaha.104.495903
Abstract
Background— This study assessed the long-term outcome of a large, asymptomatic population with hemodynamically significant aortic stenosis (AS). Methods and Results— We identified 622 patients with isolated, asymptomatic AS and peak systolic velocity ≥4 m/s by Doppler echocardiography who did not undergo surgery at the initial evaluation and obtained follow-up (5.4±4.0 years) in all. Mean age (±SD) was 72±11 years; there were 384 (62%) men. The probability of remaining free of cardiac symptoms while unoperated was 82%, 67%, and 33% at 1, 2, and 5 years, respectively. Aortic valve area and left ventricular hypertrophy predicted symptom development. During follow-up, 352 (57%) patients were referred for aortic valve surgery and 265 (43%) patients died, including cardiac death in 117 (19%). The 1-, 2-, and 5-year probabilities of remaining free of surgery or cardiac death were 80%, 63%, and 25%, respectively. Multivariate predictors of all-cause mortality were age (hazard ratio [HR], 1.05; P P =0.004), inactivity (HR, 2.00; P =0.001), and aortic valve velocity (HR, 1.46; P =0.03). Sudden death without preceding symptoms occurred in 11 (4.1%) of 270 unoperated patients. Patients with peak velocity ≥4.5 m/s had a higher likelihood of developing symptoms (relative risk, 1.34) or having surgery or cardiac death (relative risk, 1.48). Conclusions— Most patients with asymptomatic, hemodynamically significant AS will develop symptoms within 5 years. Sudden death occurs in ≈1%/y. Age, chronic renal failure, inactivity, and aortic valve velocity are independently predictive of all-cause mortality.This publication has 13 references indexed in Scilit:
- Association of cholesterol levels, hydroxymethylglutaryl coenzyme-a reductase inhibitor treatment, and progression of aortic stenosis in the communityJournal of the American College of Cardiology, 2002
- Severe pulmonary hypertension in patients with severe aortic valve stenosis: clinical profile and prognostic implicationsJournal of the American College of Cardiology, 2002
- Survival after aortic valve replacement forsevere aortic stenosis with low transvalvular gradients and severe left ventricular dysfunctionJournal of the American College of Cardiology, 2002
- Treatment decision in asymptomatic aortic valve stenosis: role of exercise testingHeart, 2001
- Predictors of Outcome in Severe, Asymptomatic Aortic StenosisThe New England Journal of Medicine, 2000
- Association of Aortic-Valve Sclerosis with Cardiovascular Mortality and Morbidity in the ElderlyThe New England Journal of Medicine, 1999
- The natural history of adults with asymptomatic, hemodynamically significant aortic stenosisJournal of the American College of Cardiology, 1990
- Comparison of outcome of asymptomatic to symptomatic patients older than 20 years of age with valvular aortic stenosisThe American Journal of Cardiology, 1988
- The natural history of aortic stenosis in adultsAmerican Heart Journal, 1980
- A point-score system for the ECG diagnosis of left ventricular hypertrophyAmerican Heart Journal, 1968