Asymptomatic aortic stenosis patients are at low risk for sudden death

  • Lancellotti P & al.
  • JAMA Cardiol
  • 3 Oct 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Despite low overall sudden-death rates in patients with asymptomatic aortic stenosis (AS), those with very severe AS have higher mortality even after aortic valve replacement (AVR). 
  • Authors suggest close follow-up for those with moderate AS plus peak aortic jet velocity of ≥3.0 m/second or left ventricular ejection fraction (LVEF)
  • Trial comparing transcatheter AVR to surveillance is underway. 
  • Editorial: if validated, results could "influence decision making and the timing of surgical referral."

Why this matters

  • It is unclear at what stage to offer AVR to asymptomatic patients.

Key results

  • Mean follow-up, 27 months.
  • 39.4% underwent AVR; 30-day postprocedural mortality: 0.9%.
  • Survival at 2, 4, and 8 years (medical management): 
    • Overall: 93%, 86%, 75%, respectively;
    • Cardiovascular death-free: 96%, 90%, 83%; 
    • Overall, with baseline severe AS: 92%, 80%, 65%;
    • AVR-free, with baseline severe AS: 54%, 32%, 12%.
  • Sudden death: 0.65%.
  • With severe AS, peak aortic jet velocity >5 m/second and LVEF  

Study design

  • Retrospective analysis of Heart Valve Clinic International Database (n=1375).
  • Patients were asymptomatic at baseline with AV area ≤1.5 cm2, LVEF >50%.
  • Outcomes: AVR, survival, natural history.
  • Funding: None disclosed; authors report industry ties.

Limitations

  • Progression rate not monitored.

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