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. 2021 Feb 19;21(1):108.
doi: 10.1186/s12872-021-01901-1.

Natural history observations in moderate aortic stenosis

Yu Du  1   2 , Mario Gössl  1 , Santiago Garcia  1 , Maurice Enriquez-Sarano  1 , Joao L Cavalcante  1 , Richard Bae  1 , Go Hashimoto  1 , Miho Fukui  1 , Bernardo Lopes  1 , Aisha Ahmed  1 , Christian Schmidt  1 , Larissa Stanberry  1 , Ross Garberich  1 , Steven M Bradley  1 , Robert Steffen  1 , Paul Sorajja  3
Affiliations

Natural history observations in moderate aortic stenosis

Yu Du et al. BMC Cardiovasc Disord. .

Abstract

Background: The natural history of patients with moderate aortic stenosis (AS) is poorly understood. We aimed to determine the long-term outcomes of patients with moderate AS.

Methods: We examined patients with moderate AS defined by echocardiography in our healthcare system, and performed survival analyses for occurrence of death, heart failure (HF) hospitalization, and progression of AS, with accounting for symptoms, left ventricular dysfunction, and comorbidities.

Results: We examined 729 patients with moderate AS (median age, 76 years; 59.9 % men) with a median follow-up of 5.0 years (interquartile range: 2.0 to 8.1 years). The 5-year overall survival was 52.3 % (95 % confidence interval [CI]: 48.6 % to 56.0 %) and survival free of death or HF hospitalization was 43.2 % (95 % CI: 39.5 % to 46.9 %). Worse New York Heart Association (NYHA) functional class was associated with poor long-term survival, with mortality rates ranging from 7.9 % (95 % CI: 6.6-9.2 %) to 25.2 % (95 % CI: 20.2-30.3 %) per year. Among patients with minimal or no symptoms, no futility markers, and preserved left ventricular function, 5-year overall survival was 71.9 % (95 % CI: 66.4-77.4 %) and survival free of death or HF hospitalization was 61.4 % (95 % CI: 55.5-67.3 %). Risk factors associated with adverse events were age, NYHA class, low ejection fraction and high aortic valve velocity (all p < 0.05).

Conclusions: Patients with moderate AS are at significant risk of death. Our findings highlight the need for more study into appropriate therapeutic interventions to improve the prognosis of these patients.

Keywords: Aortic stenosis; Aortic valve replacement; Moderate; Outcomes; Survival.

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Conflict of interest statement

Dr. Gössl serves as a consultant for Abbott Structural. Dr. Garcia receives Institutional Research grants from Edwards Lifesciences and Boston Scientific; proctors Edwards Lifesciences. Dr. Sarano is a consultant for Cryolife inc, Edwards Lifesciences LLC. Dr. Cavalcante serves as a consultant for Boston Scientific, Abbott Vascular; a speaker for Medtronic, Circle Cardiovascular Imaging, and Siemens Healthineers; receives research grant support from Circle Cardiovascular Imaging, Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott Vascular. Dr. Bae is a consultant for Abbott Structural. Dr. Sorajja is a consultant for Abbott Structural, Anteris, Boston Scientific, Edwards Lifesciences, Medtronic, TeleFlex, WL Gore. The other authors report no conflict of interest.

Figures

Fig. 1
Fig. 1
Survival of patients with moderate aortic stenosis. Observed survival free of all-cause mortality (solid) for the entire study cohort in comparison to the expected survival, based on the age- and sex-matched total Minnesota population (dashed), is shown
Fig. 2
Fig. 2
Survival according to baseline New York Heart Association (NYHA) functional class for the entire cohort. a Survival free of death. b Survival free of death and heart failure (HF) hospitalization
Fig. 3
Fig. 3
Disease progression for patients with moderate aortic stenosis. a Incidence of disease progression to severe aortic stenosis among patients with echocardiography in follow-up (n = 517). b Incidence of aortic valve replacement in the entire cohort (n = 729)
Fig. 4
Fig. 4
Survival in patients with moderate aortic stenosis who were without severe morbidities, with survival times censored at aortic valve replacement (N = 639). a Observed survival (solid) in comparison to the expected survival based on the age- and sex-matched total Minnesota population (dashed). b Observed survival according to New York Heart Association (NYHA) functional class
See this image and copyright information in PMC

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