Published online before print June 13, 2005, doi: 10.1161/CIRCULATIONAHA.104.495903
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(Circulation. 2005;111:3290-3295.)
© 2005 American Heart Association, Inc.
Valvular Heart Disease |
Outcome of 622 Adults With Asymptomatic, Hemodynamically Significant Aortic Stenosis During Prolonged Follow-Up
From the Division of Cardiovascular Diseases (P.A.P., M.E.S., R.A.N., J.F.M., M.E.B., A.J.T.) and the Division of Biostatistics (K.R.B., C.G.S.), Mayo Clinic and Mayo Foundation, Rochester, Minn.
Correspondence to Patricia A Pellikka, MD, Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, 200 First St SW, Rochester, MN 55905. E-mail pellikka.patricia{at}mayo.edu
Received July 29, 2004; revision received February 23, 2005; accepted March 4, 2005.
Background— This study assessed the long-term outcome of a large, asymptomatic population with hemodynamically significant aortic stenosis (AS).
Methods and Results— We identified 622 patients with isolated, asymptomatic AS and peak systolic velocity 
4 m/s by Doppler echocardiography who did not undergo surgery at the initial evaluation and obtained follow-up (5.4±4.0 years) in all. Mean age (±SD) was 72±11 years; there were 384 (62%) men. The probability of remaining free of cardiac symptoms while unoperated was 82%, 67%, and 33% at 1, 2, and 5 years, respectively. Aortic valve area and left ventricular hypertrophy predicted symptom development. During follow-up, 352 (57%) patients were referred for aortic valve surgery and 265 (43%) patients died, including cardiac death in 117 (19%). The 1-, 2-, and 5-year probabilities of remaining free of surgery or cardiac death were 80%, 63%, and 25%, respectively. Multivariate predictors of all-cause mortality were age (hazard ratio [HR], 1.05; P<0.0001), chronic renal failure (HR, 2.41; P=0.004), inactivity (HR, 2.00; P=0.001), and aortic valve velocity (HR, 1.46; P=0.03). Sudden death without preceding symptoms occurred in 11 (4.1%) of 270 unoperated patients. Patients with peak velocity 4.5 m/s had a higher likelihood of developing symptoms (relative risk, 1.34) or having surgery or cardiac death (relative risk, 1.48).
Conclusions— Most patients with asymptomatic, hemodynamically significant AS will develop symptoms within 5 years. Sudden death occurs in 
1%/y. Age, chronic renal failure, inactivity, and aortic valve velocity are independently predictive of all-cause mortality.
Key Words: echocardiography • surgery • survival • valves • aortic stenosis
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