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. 2018 Jul 4;8(1):10080.
doi: 10.1038/s41598-018-28162-x.

Asymptomatic versus Symptomatic Patients with Severe Aortic Stenosis

Norio Kanamori  1 , Tomohiko Taniguchi  2 , Takeshi Morimoto  3 , Hiroki Shiomi  2 , Kenji Ando  4 , Koichiro Murata  5 , Takeshi Kitai  6 , Yuichi Kawase  7 , Chisato Izumi  8 , Makoto Miyake  8 , Hirokazu Mitsuoka  9 , Masashi Kato  10 , Yutaka Hirano  11 , Shintaro Matsuda  2 , Kazuya Nagao  12 , Tsukasa Inada  12 , Hiroshi Mabuchi  13 , Yasuyo Takeuchi  14 , Keiichiro Yamane  15 , Mamoru Toyofuku  16 , Mitsuru Ishii  17 , Eri Minamino-Muta  2 , Takao Kato  2 , Moriaki Inoko  18 , Tomoyuki Ikeda  19 , Akihiro Komasa  20 , Katsuhisa Ishii  20 , Kozo Hotta  21 , Nobuya Higashitani  22 , Yoshihiro Kato  23 , Yasutaka Inuzuka  24 , Chiyo Maeda  25 , Toshikazu Jinnai  22 , Yuko Morikami  26 , Naritatsu Saito  2 , Kenji Minatoya  27 , Takeshi Aoyama  1 , Takeshi Kimura  28 ; CURRENT AS registry Investigators
Collaborators, Affiliations

Asymptomatic versus Symptomatic Patients with Severe Aortic Stenosis

Norio Kanamori et al. Sci Rep. .

Abstract

It is unknown how much different are the clinical outcomes between asymptomatic and symptomatic patients with severe aortic stenosis (AS). In the CURRENT AS registry enrolling 3,815 consecutive patients with severe AS, we compared the long-term outcomes between 1808 asymptomatic and 1215 symptomatic patients (exertional dyspnea: N = 813, syncope: N = 136, and angina: N = 266) without heart failure (HF) hospitalization. Symptomatic patients had greater AS severity, and more depressed left ventricular function than asymptomatic patients without much difference in other baseline characteristics. During a median follow-up of 3.2 years, aortic valve replacement (AVR) was performed in 62% of symptomatic patients, and 38% of asymptomatic patients. The cumulative 5-year incidences for the primary outcome measure (a composite of aortic valve-related death or HF hospitalization) was higher in symptomatic patients than in asymptomatic patients (32.3% versus 27.6%, P < 0.001). After adjusting for AVR and other variables, the greater risk of symptomatic relative to asymptomatic patients for the primary outcome measure was significant (hazard ratio 1.64, 95% confidence interval 1.41-1.96, P < 0.001). In conclusions, the excess risk of symptomatic relative to asymptomatic patients with severe AS for the aortic valve-related event was significant. However, the prevalence of AVR in symptomatic patients was not optimal.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Study patient flow. AS = aortic stenosis; AHF = acute heart failure; AVA = aortic valve area; AVR = aortic valve replacement; PG = pressure gradient; Vmax = peak aortic jet velocity.
Figure 2
Figure 2
Cumulative incidence of surgical AVR or TAVI: Symptomatic versus Asymptomatic patients. AVR = aortic valve replacement; TAVI = transcatheter aortic valve implantation.
Figure 3
Figure 3
Cumulative incidence of the primary outcome measure (aortic valve-related death or HF hospitalization): Symptomatic versus Asymptomatic patients. HF = heart failure.
See this image and copyright information in PMC

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