Natural History of Very Severe Aortic Stenosis

Circulation. 2010; 121(1):151-156

Rosenhek R, Zilberszac R, Schemper M, Czerny M, Mundigler G, Graf S, Bergler-Klein J, Grimm M, Gabriel H, Maurer G

OBJECTIVES: We sought to assess the outcome of asymptomatic patients with very severe aortic stenosis.

METHODS: We prospectively followed 116 consecutive asymptomatic patients (57 women; age, 67 + or – 16 years) with very severe isolated aortic stenosis defined by a peak aortic jet velocity (AV-Vel) > 5.0 m/s (average AV-Vel, 5.37 + or – 0.35 m/s; valve area, 0.63 + or – 0.12 cm(2)).

RESULTS: During a median follow-up of 41 months (interquartile range, 26 to 63 months), 96 events occurred (indication for aortic valve replacement, 90; cardiac deaths, 6). Event-free survival was 64%, 36%, 25%, 12%, and 3% at 1, 2, 3, 4, and 6 years, respectively. AV-Vel but not aortic valve area was shown to independently affect event-free survival. Patients with an AV-Vel > 5.5 m/s had an event-free survival of 44%, 25%, 11%, and 4% at 1, 2, 3, and 4 years, respectively, compared with 76%, 43%, 33%, and 17% for patients with an AV-Vel between 5.0 and 5.5 m/s (P<0.0001). Six cardiac deaths occurred in previously asymptomatic patients (sudden death, 1; congestive heart failure, 4; myocardial infarction, 1). Patients with an initial AV-Vel > 5.5 m/s had a higher likelihood (52%) of severe symptom onset (New York Heart Association or Canadian Cardiovascular Society class >II) than those with an AV-Vel between 5.0 and 5.5 m/s (27%; P=0.03).

CONCLUSIONS: Despite being asymptomatic, patients with very severe aortic stenosis have a poor prognosis with a high event rate and a risk of rapid functional deterioration. Early elective valve replacement surgery should therefore be considered in these patients.

PMID: 20026771

2 Responses

  1. Paul Schoenhagen, MD  on January 16th, 2010

    Please compare to post from January 10th:

    Myocardial Deformation in Aortic Valve Stenosis: Relation to Left Ventricular Geometry.
    Dana Cramariuc, Eva Gerdts, Einar Skulstad Davidsen, Leidulf Segadal, Knut Matre.
    Heart . 2010; 96(1):106-112.
    PMID: 19710026

  2. Jacobo Kirsch, MD  on January 30th, 2010

    Interesting study analyzing a sizable group of asymptomatic patients! The results indicate that very severe stenosis carries an increased risk of rapid deterioration and poor reserve of adaptation to hemodynamic stress.
    I found very interesting that the AVA (a matter of interest for CT examinations of the heart) did not affect the outcome of patients with very severe AS as defined by a peak jet velocity of >5.0 m/s. In this group, AVA was estimated by the continuity equation… should we expect a difference if AVA was directly measured using MRI or CT?


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