Natural History of Very Severe Aortic Stenosis
We sought to assess the outcome of asymptomatic patients with very severe aortic stenosis. 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) > or = 5.0 m/s (a...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2010-01, Vol.121 (1), p.151-156 |
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| creator | ROSENHEK, Raphael ZILBERSZAC, Robert SCHEMPER, Michael CZERNY, Martin MUNDIGLER, Gerald GRAF, Senta BERGLER-KLEIN, Jutta GRIMM, Michael GABRIEL, Harald MAURER, Gerald |
| description | We sought to assess the outcome of asymptomatic patients with very severe aortic stenosis.
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) > or = 5.0 m/s (average AV-Vel, 5.37 + or - 0.35 m/s; valve area, 0.63 + or - 0.12 cm(2)). 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 > or = 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 or = 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).
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. |
| doi_str_mv | 10.1161/circulationaha.109.894170 |
| format | Article |
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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) > or = 5.0 m/s (average AV-Vel, 5.37 + or - 0.35 m/s; valve area, 0.63 + or - 0.12 cm(2)). 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 > or = 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 > or = 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).
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.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/circulationaha.109.894170</identifier><identifier>PMID: 20026771</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Aged, 80 and over ; Aortic Valve - physiopathology ; Aortic Valve - surgery ; Aortic Valve Stenosis - mortality ; Aortic Valve Stenosis - physiopathology ; Aortic Valve Stenosis - surgery ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Cause of Death ; Death, Sudden, Cardiac - epidemiology ; Disease-Free Survival ; Diseases of the aorta ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Female ; Follow-Up Studies ; Heart Valve Prosthesis - statistics & numerical data ; Humans ; Kaplan-Meier Estimate ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Prognosis ; Risk Factors ; Severity of Illness Index</subject><ispartof>Circulation (New York, N.Y.), 2010-01, Vol.121 (1), p.151-156</ispartof><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c504t-f1cb303db9ed3f0e7a60814d50a7fbb082bb89840f9df61491ac8cabacdf22b3</citedby><cites>FETCH-LOGICAL-c504t-f1cb303db9ed3f0e7a60814d50a7fbb082bb89840f9df61491ac8cabacdf22b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22333345$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20026771$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>ROSENHEK, Raphael</creatorcontrib><creatorcontrib>ZILBERSZAC, Robert</creatorcontrib><creatorcontrib>SCHEMPER, Michael</creatorcontrib><creatorcontrib>CZERNY, Martin</creatorcontrib><creatorcontrib>MUNDIGLER, Gerald</creatorcontrib><creatorcontrib>GRAF, Senta</creatorcontrib><creatorcontrib>BERGLER-KLEIN, Jutta</creatorcontrib><creatorcontrib>GRIMM, Michael</creatorcontrib><creatorcontrib>GABRIEL, Harald</creatorcontrib><creatorcontrib>MAURER, Gerald</creatorcontrib><title>Natural History of Very Severe Aortic Stenosis</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>We sought to assess the outcome of asymptomatic patients with very severe aortic stenosis.
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) > or = 5.0 m/s (average AV-Vel, 5.37 + or - 0.35 m/s; valve area, 0.63 + or - 0.12 cm(2)). 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 > or = 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 > or = 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).
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.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Valve - physiopathology</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Stenosis - mortality</subject><subject>Aortic Valve Stenosis - physiopathology</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Cause of Death</subject><subject>Death, Sudden, Cardiac - epidemiology</subject><subject>Disease-Free Survival</subject><subject>Diseases of the aorta</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart Valve Prosthesis - statistics & numerical data</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Prognosis</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkN9LwzAQx4Mobk7_BakP4lPr5Ueb5rEUdYOxgZu-liRNsNI1mrTC_nsrm3ovX-743B18ELrBkGCc4XvdeD20sm9cJ99kgkEkuWCYwwma4pSwmKVUnKIpAIiYU0Im6CKE97HNKE_P0YQAkIxzPEXJSvaDl200b0Lv_D5yNno1Y27Ml_EmKpzvGx1tetO50IRLdGZlG8zVMWdo-_iwLefxcv20KItlrFNgfWyxVhRorYSpqQXDZQY5ZnUKklulICdK5SJnYEVtM8wEljrXUkldW0IUnaG7w9kP7z4HE_pq1wRt2lZ2xg2h4pQRgoHzkRQHUnsXgje2-vDNTvp9haH6kVWVi-fyZVlsF-tVMS_GsagOssbd6-OXQe1M_bf5a2cEbo-ADFq21stON-GfI3Ss0fU3AJp1Vg</recordid><startdate>20100105</startdate><enddate>20100105</enddate><creator>ROSENHEK, Raphael</creator><creator>ZILBERSZAC, Robert</creator><creator>SCHEMPER, Michael</creator><creator>CZERNY, Martin</creator><creator>MUNDIGLER, Gerald</creator><creator>GRAF, Senta</creator><creator>BERGLER-KLEIN, Jutta</creator><creator>GRIMM, Michael</creator><creator>GABRIEL, Harald</creator><creator>MAURER, Gerald</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20100105</creationdate><title>Natural History of Very Severe Aortic Stenosis</title><author>ROSENHEK, Raphael ; ZILBERSZAC, Robert ; SCHEMPER, Michael ; CZERNY, Martin ; MUNDIGLER, Gerald ; GRAF, Senta ; BERGLER-KLEIN, Jutta ; GRIMM, Michael ; GABRIEL, Harald ; MAURER, Gerald</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c504t-f1cb303db9ed3f0e7a60814d50a7fbb082bb89840f9df61491ac8cabacdf22b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Valve - physiopathology</topic><topic>Aortic Valve - surgery</topic><topic>Aortic Valve Stenosis - mortality</topic><topic>Aortic Valve Stenosis - physiopathology</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Cause of Death</topic><topic>Death, Sudden, Cardiac - epidemiology</topic><topic>Disease-Free Survival</topic><topic>Diseases of the aorta</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart Valve Prosthesis - statistics & numerical data</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Prognosis</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>ROSENHEK, Raphael</creatorcontrib><creatorcontrib>ZILBERSZAC, Robert</creatorcontrib><creatorcontrib>SCHEMPER, Michael</creatorcontrib><creatorcontrib>CZERNY, Martin</creatorcontrib><creatorcontrib>MUNDIGLER, Gerald</creatorcontrib><creatorcontrib>GRAF, Senta</creatorcontrib><creatorcontrib>BERGLER-KLEIN, Jutta</creatorcontrib><creatorcontrib>GRIMM, Michael</creatorcontrib><creatorcontrib>GABRIEL, Harald</creatorcontrib><creatorcontrib>MAURER, Gerald</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>ROSENHEK, Raphael</au><au>ZILBERSZAC, Robert</au><au>SCHEMPER, Michael</au><au>CZERNY, Martin</au><au>MUNDIGLER, Gerald</au><au>GRAF, Senta</au><au>BERGLER-KLEIN, Jutta</au><au>GRIMM, Michael</au><au>GABRIEL, Harald</au><au>MAURER, Gerald</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Natural History of Very Severe Aortic Stenosis</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2010-01-05</date><risdate>2010</risdate><volume>121</volume><issue>1</issue><spage>151</spage><epage>156</epage><pages>151-156</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>We sought to assess the outcome of asymptomatic patients with very severe aortic stenosis.
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) > or = 5.0 m/s (average AV-Vel, 5.37 + or - 0.35 m/s; valve area, 0.63 + or - 0.12 cm(2)). 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 > or = 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 > or = 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).
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.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>20026771</pmid><doi>10.1161/circulationaha.109.894170</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Aortic Valve - physiopathology Aortic Valve - surgery Aortic Valve Stenosis - mortality Aortic Valve Stenosis - physiopathology Aortic Valve Stenosis - surgery Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Cause of Death Death, Sudden, Cardiac - epidemiology Disease-Free Survival Diseases of the aorta Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Female Follow-Up Studies Heart Valve Prosthesis - statistics & numerical data Humans Kaplan-Meier Estimate Male Medical sciences Middle Aged Multivariate Analysis Prognosis Risk Factors Severity of Illness Index |
| title | Natural History of Very Severe Aortic Stenosis |
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