Outcome of 622 Adults With Asymptomatic, Hemodynamically Significant Aortic Stenosis During Prolonged Follow-Up

P. A. Pellikka
2005 Circulation  
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 Ն4 m/s by Doppler echocardiography who did not undergo surgery at the initial evaluation and obtained follow-up (5.4Ϯ4.0 years) in all. Mean age (ϮSD) was 72Ϯ11 years; there were 384 (62%) men. The probability of remaining free of cardiac symptoms
more » ... le 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; PϽ0.0001), chronic renal failure (HR, 2.41; Pϭ0.004), inactivity (HR, 2.00; Pϭ0.001), and aortic valve velocity (HR, 1.46; Pϭ0.03). Sudden death without preceding symptoms occurred in 11 (4.1%) of 270 unoperated patients. Patients with peak velocity Ն4.5 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 Ϸ1%/y. Age, chronic renal failure, inactivity, and aortic valve velocity are independently predictive of all-cause mortality. (Circulation. 2005;111:3290-3295.)
doi:10.1161/circulationaha.104.495903 pmid:15956131 fatcat:rwzr4fqkrrfjjluj5rmr7m2ir4