Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Nov 1;3(11):1060-1068.
doi: 10.1001/jamacardio.2018.3152.

Outcomes of Patients With Asymptomatic Aortic Stenosis Followed Up in Heart Valve Clinics

Patrizio Lancellotti  1   2 , Julien Magne  3 , Raluca Dulgheru  1 , Marie-Annick Clavel  4 , Erwan Donal  5 , Mani A Vannan  6 , John Chambers  7 , Raphael Rosenhek  8 , Gilbert Habib  9   10 , Guy Lloyd  11 , Stefano Nistri  12 , Madalina Garbi  13 , Stella Marchetta  1 , Khalil Fattouch  14   15 , Augustin Coisne  16 , David Montaigne  16 , Thomas Modine  16 , Laurent Davin  1 , Olivier Gach  1 , Marc Radermecker  1 , Shizhen Liu  6 , Linda Gillam  17 , Andrea Rossi  18 , Elena Galli  5 , Federica Ilardi  1 , Lionel Tastet  4 , Romain Capoulade  4 , Robert Zilberszac  8 , E Mara Vollema  19 , Victoria Delgado  19 , Bernard Cosyns  20 , Stephane Lafitte  21 , Anne Bernard  22   23 , Luc A Pierard  1 , Jeroen J Bax  19 , Philippe Pibarot  4 , Cécile Oury  1
Affiliations

Outcomes of Patients With Asymptomatic Aortic Stenosis Followed Up in Heart Valve Clinics

Patrizio Lancellotti et al. JAMA Cardiol. .

Abstract

Importance: The natural history and the management of patients with asymptomatic aortic stenosis (AS) have not been fully examined in the current era.

Objective: To determine the clinical outcomes of patients with asymptomatic AS using data from the Heart Valve Clinic International Database.

Design, setting, and participants: This registry was assembled by merging data from prospectively gathered institutional databases from 10 heart valve clinics in Europe, Canada, and the United States. Asymptomatic patients with an aortic valve area of 1.5 cm2 or less and preserved left ventricular ejection fraction (LVEF) greater than 50% at entry were considered for the present analysis. Data were collected from January 2001 to December 2014, and data were analyzed from January 2017 to July 2018.

Main outcomes and measures: Natural history, need for aortic valve replacement (AVR), and survival of asymptomatic patients with moderate or severe AS at entry followed up in a heart valve clinic. Indications for AVR were based on current guideline recommendations.

Results: Of the 1375 patients included in this analysis, 834 (60.7%) were male, and the mean (SD) age was 71 (13) years. A total of 861 patients (62.6%) had severe AS (aortic valve area less than 1.0 cm2). The mean (SD) overall survival during medical management (mean [SD] follow up, 27 [24] months) was 93% (1%), 86% (2%), and 75% (4%) at 2, 4, and 8 years, respectively. A total of 104 patients (7.6%) died under observation, including 57 patients (54.8%) from cardiovascular causes. The crude rate of sudden death was 0.65% over the duration of the study. A total of 542 patients (39.4%) underwent AVR, including 388 patients (71.6%) with severe AS at study entry and 154 (28.4%) with moderate AS at entry who progressed to severe AS. Those with severe AS at entry who underwent AVR did so at a mean (SD) of 14.4 (16.6) months and a median of 8.7 months. The mean (SD) 2-year and 4-year AVR-free survival rates for asymptomatic patients with severe AS at baseline were 54% (2%) and 32% (3%), respectively. In those undergoing AVR, the 30-day postprocedural mortality was 0.9%. In patients with severe AS at entry, peak aortic jet velocity (greater than 5 m/s) and LVEF (less than 60%) were associated with all-cause and cardiovascular mortality without AVR; these factors were also associated with postprocedural mortality in those patients with severe AS at baseline who underwent AVR (surgical AVR in 310 patients; transcatheter AVR in 78 patients).

Conclusions and relevance: In patients with asymptomatic AS followed up in heart valve centers, the risk of sudden death is low, and rates of overall survival are similar to those reported from previous series. Patients with severe AS at baseline and peak aortic jet velocity of 5.0 m/s or greater or LVEF less than 60% have increased risks of all-cause and cardiovascular mortality even after AVR. The potential benefit of early intervention should be considered in these high-risk patients.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Vannan has received grants from Abbott, Medtronic, and Siemens. Dr Lloyd has received personal fees from Edwards Lifesciences, grants from Medtronic, and nonfinancial support from Sorin Group. Drs Delgado and Bax have received grants from Biotronik, Boston Scientific, Edwards Lifesciences, and Medtronic paid to the Department of Cardiology of Leiden University Medical Center. Dr Delgado has received personal fees from Abbott Vascular. Dr Pibarot has received grants from Edwards Lifesciences an Medtronic. Dr Oury is a senior research associate at the National Fund for Scientific Research (FRS-FNRS). No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Kaplan-Meier Estimates for Events in Patients With Severe Aortic Stenosis (AS)
Kaplan-Meier analyses of overall survival (A), cardiovascular death–free survival (B), and aortic valve replacement (AVR)–free survival (C) for patients with severe AS at entry to the registry.
Figure 2.
Figure 2.. Kaplan-Meier Estimates for Events in Patients With Severe Aortic Stenosis According to Left Ventricular Ejection Fraction (LVEF) and Peak Aortic Jet Velocity
Kaplan-Meier analyses of overall survival in patients with severe aortic stenosis at baseline as a function of peak aortic jet velocity (A) and LVEF (B). aSignificant difference with peak aortic jet velocity of 5 m/s or greater. bSignificant difference with LVEF less than 60%. cSignificant difference with LVEF of 60% to 65%.
See this image and copyright information in PMC

Comment in

References

    1. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005-1011. doi:10.1016/S0140-6736(06)69208-8 - DOI - PubMed
    1. Rossebø AB, Pedersen TR, Boman K, et al. ; SEAS Investigators . Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med. 2008;359(13):1343-1356. doi:10.1056/NEJMoa0804602 - DOI - PubMed
    1. Kodali SK, Williams MR, Smith CR, et al. ; PARTNER Trial Investigators . Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012;366(18):1686-1695. doi:10.1056/NEJMoa1200384 - DOI - PubMed
    1. Smith CR, Leon MB, Mack MJ, et al. ; PARTNER Trial Investigators . Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187-2198. doi:10.1056/NEJMoa1103510 - DOI - PubMed
    1. Baumgartner H, Falk V, Bax JJ, et al. ; ESC Scientific Document Group . 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739-2791. doi:10.1093/eurheartj/ehx391 - DOI - PubMed