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Circulation. 2005;111:3290-3295
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

Patricia A. Pellikka, MD; Maurice E. Sarano, MD; Rick A. Nishimura, MD; Joseph F. Malouf, MD; Kent R. Bailey, PhD; Christopher G. Scott, MS; Marion E. Barnes, MSc; A. Jamil Tajik, MD

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 {approx}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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