Lancellotti P, et al. - Using data from the Heart Valve Clinic International Database, experts assessed the clinical outcomes of patients with asymptomatic aortic stenosis (AS). The risk of sudden death in patients with asymptomatic AS followed up in heart valve centers is low, and similar rates of overall survival to those reported from the previous series was noted. Increased risks of all-cause and cardiovascular mortality, even after AVR, were seen in patients with severe AS at baseline and peak aortic jet velocity of 5.0 m/s or greater or LVEF less than 60%. Findings suggested considering the potential benefit of early intervention in these high-risk patients.

Methods

• Researchers assembled the registry by merging data from prospectively gathered institutional databases from 10 heart valve clinics in Europe, Canada, and the US.
• They considered the 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 for this analysis.
• They collected the data from January 2001 to December 2014 and analyzed it from January 2017 to July 2018.
• Natural history, need for aortic valve replacement (AVR), and survival of asymptomatic patients with moderate or severe AS at entry followed up in a heart valve clinic were included in the main outcomes and measures.
• 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 93% (1%), 86% (2%), and 75% (4%) at 2, 4, and 8 years, respectively to be the mean (SD) overall survival during medical management (mean [SD] follow up, 27 [24] months) .
• Death while under observation was reported for a total of 104 patients (7.6%), including 57 patients (54.8%) due to cardiovascular causes.
• Data demonstrated that 0.65% was the crude rate of sudden death over the time of the study.
• AVR was carried out in a total of 542 patients (39.4%), 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.
• Authors noted 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.
• For asymptomatic patients with severe AS at baseline, the mean (SD) 2-year and 4-year AVR-free survival rates were 54% (2%) and 32% (3%), respectively.
• The 30-day postprocedural mortality in those undergoing AVR was 0.9%.
• 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; they noted a correlation 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).