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Untreated aortic stenosis confers poor survival regardless if moderate or severe
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PARIS — Patients with aortic stenosis have poor survival rates if their condition is left untreated, regardless of whether their stenosis is moderate or severe, researchers reported at the European Society of Cardiology Congress.
According to the study simultaneously published in the Journal of the American College of Cardiology, patients with moderate to severe aortic stenosis had increased risk for long-term mortality (adjusted HR range, 1.44-2.09; P < .001 for all) compared with individuals with no aortic stenosis.
Additionally, patients with severe aortic stenosis (mean gradient, at least 40 mm Hg; peak velocity at least 4 m/s) had a 5-year mortality rate of 67%.
Similarly, the moderate aortic stenosis group (mean gradient, 20 to 39 mm Hg; peak velocity 3 to 3.9 m/s) had a 5-year mortality rate of 56%.
“We are entering a new era of aortic valve stenosis management. Surgical aortic valve replacement is safer than ever before, and transcatheter interventions are now indicated for low surgical risk, severe symptomatic aortic stenosis,” Geoff Strange, PhD, professor at the University of Notre Dame School of Medicine in Freemantle, Australia, told Healio. “As the threshold continues to be lowered, our data have provided the impetus for evaluation of those with moderate aortic stenosis not previously considered for active management.” In other findings, after adjustment for age, sex, left ventricular systolic function, diastolic dysfunction and aortic regurgitation, patients with moderate or worse aortic stenosis were at elevated risk for all-cause mortality and CV death compared with those with no aortic stenosis.
“We have shown for the first time, in the largest study of aortic stenosis ever undertaken, that aortic stenosis is not a benign disease throughout the spectrum of severity,” Strange told Healio. “The current ‘watchful waiting’ approach to non-severe aortic stenosis mandates serious consideration. Patients in the moderate group of our study had very similar 5-year mortality outcomes to the severe group. For echocardiography, a comprehensive approach with detailed attention to aortic gradients, along with careful evaluation for all of the typical adaptive changes in the ventricle that occur with aortic stenosis, is a must. In addition, attention to a detailed clinical history taking of patients in the moderate group, as is currently recommended in the severe group.”
Researchers used data from the National Echocardiographic Database of Australia to characterize patients by aortic stenosis severity, aortic valve mean gradient as well as peak velocity and/or area to determine the association between aortic stenosis severity and long-term survival. The researchers analyzed a cohort of 241,303 adults (49% women; mean age, 62 years) over a median follow-up of 1,198 days. Among the participants, 6.7% had mild aortic stenosis, 1.4% had moderate aortic stenosis and 2.6% had severe aortic stenosis.
“In the light of our data, there needs to be a series of new studies designed, intended to examine whether patients with moderate aortic stenosis die with the disease, or die because of the disease,” Strange said in an interview. “This may help guide future studies on earlier aortic valve intervention in the moderate group. With the very high mortality observed in our study in moderate aortic stenosis, there may be potential to save many lives by timely intervention in at-risk populations.” – by Scott Buzby
References:
Strange G, et al. Late-Breaking Science in Aortic Stenosis. Presented at: European Society of Cardiology Congress; Aug. 31 to Sept. 4, 2019; Paris.
Strange G, et al. J Am Coll Cardiol. 2019;doi:10.1016/j.jacc.2019.08.004
Disclosures: Strange reports no relevant financial disclosures.