Document Detail

Natural history of very severe aortic stenosis.
MedLine Citation:
PMID:  20026771     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: We sought to assess the outcome of asymptomatic patients with very severe aortic stenosis. METHODS AND RESULTS: We prospectively followed 116 consecutive asymptomatic patients (57 women; age, 67 + or - 16 years) with very severe isolated aortic stenosis defined by a peak aortic jet velocity (AV-Vel) > or = 5.0 m/s (average AV-Vel, 5.37 + or - 0.35 m/s; valve area, 0.63 + or - 0.12 cm(2)). During a median follow-up of 41 months (interquartile range, 26 to 63 months), 96 events occurred (indication for aortic valve replacement, 90; cardiac deaths, 6). Event-free survival was 64%, 36%, 25%, 12%, and 3% at 1, 2, 3, 4, and 6 years, respectively. AV-Vel but not aortic valve area was shown to independently affect event-free survival. Patients with an AV-Vel > or = 5.5 m/s had an event-free survival of 44%, 25%, 11%, and 4% at 1, 2, 3, and 4 years, respectively, compared with 76%, 43%, 33%, and 17% for patients with an AV-Vel between 5.0 and 5.5 m/s (P<0.0001). Six cardiac deaths occurred in previously asymptomatic patients (sudden death, 1; congestive heart failure, 4; myocardial infarction, 1). Patients with an initial AV-Vel > or = 5.5 m/s had a higher likelihood (52%) of severe symptom onset (New York Heart Association or Canadian Cardiovascular Society class >II) than those with an AV-Vel between 5.0 and 5.5 m/s (27%; P=0.03). CONCLUSIONS: Despite being asymptomatic, patients with very severe aortic stenosis have a poor prognosis with a high event rate and a risk of rapid functional deterioration. Early elective valve replacement surgery should therefore be considered in these patients.
Raphael Rosenhek; Robert Zilberszac; Michael Schemper; Martin Czerny; Gerald Mundigler; Senta Graf; Jutta Bergler-Klein; Michael Grimm; Harald Gabriel; Gerald Maurer
Publication Detail:
Type:  Journal Article     Date:  2009-12-21
Journal Detail:
Title:  Circulation     Volume:  121     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-05     Completed Date:  2010-01-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  151-6     Citation Subset:  AIM; IM    
Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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MeSH Terms
Aged, 80 and over
Aortic Valve / physiopathology,  surgery
Aortic Valve Stenosis* / mortality,  physiopathology,  surgery
Cause of Death
Death, Sudden, Cardiac / epidemiology
Disease-Free Survival
Follow-Up Studies
Heart Valve Prosthesis / statistics & numerical data*
Kaplan-Meiers Estimate
Middle Aged
Multivariate Analysis
Risk Factors
Severity of Illness Index*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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