Lancellotti P, et al. - Authors ascertained the clinical outcomes of patients with asymptomatic aortic stenosis (AS) using data from the Heart Valve Clinic International Database. In addition to low risk of sudden death, similar rates of overall survival to those reported from previous series was seen in patients with asymptomatic AS followed up in heart valve centers. Increased risks of all-cause and cardiovascular mortality, even after aortic valve replacement (AVR) were seen in patients with severe AS at baseline and peak aortic jet velocity of 5.0 m/s or greater or left ventricular ejection fraction (LVEF) less than 60%. In these high-risk patients, the potential benefit of early intervention should be considered.

Methods

• Experts assembled this registry by merging data from prospectively gathered institutional databases from 10 heart valve clinics in Europe, Canada, and the US.
• For the present analysis, they considered 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.
• Data were collected from January 2001 to December 2014; data were analyzed from January 2017 to July 2018.
• Main outcomes and measures included the natural history, need for AVR, and survival of asymptomatic patients with moderate or severe AS at entry followed up in a heart valve clinic.
• They noted the indications for AVR to be based on current guideline recommendations.

Results

• As per data, out of the 1,375 patients included in this analysis, 834 (60.7%) were male, and the mean (SD) age was 71 (13) years.
• Severe AS (aortic valve area less than 1.0 cm²) was seen in a total of 861 patients (62.6%).
• Findings suggested the mean (SD) overall survival during medical management (mean [SD] follow up, 27 [24] months) to be 93% (1%), 86% (2%), and 75% (4%) at 2, 4, and 8 years, respectively.
• They noted a total of 104 (7.6%) deaths under observation, including 57 patients (54.8%) from cardiovascular causes.
• Over the duration of the study, the crude rate of sudden death was 0.65%.
• 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, a total of 542 patients (39.4%) underwent AVR.
• Results demonstrated that 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.
• They noted 54% (2%) and 32% (3%), respectively, to be the mean (SD) 2-year and 4-year AVR-free survival rates for asymptomatic patients with severe AS at baseline.
• The 30-day postprocedural mortality was 0.9% in those undergoing AVR.
• In patients with severe AS at entry, an association of peak aortic jet velocity (greater than 5 m/s) and LVEF (less than 60%) with all-cause and cardiovascular mortality without AVR was seen.
• Moreover, they noted an association of these factors with postprocedural mortality in those patients with severe AS at baseline who underwent AVR (surgical AVR in 310 patients; transcatheter AVR in 78 patients).