Background-We sought to assess the outcome of asymptomatic patients with very severe aortic stenosis. Methods and Results-We prospectively followed 116 consecutive asymptomatic patients (57 women; age, 67Ϯ16 years) with very severe isolated aortic stenosis defined by a peak aortic jet velocity (AV-Vel) Ն5.0 m/s (average AV-Vel, 5.37Ϯ0.35 m/s; valve area, 0.63Ϯ0.12 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 Ն5.5 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 (PϽ0.0001). Six cardiac deaths occurred in previously asymptomatic patients (sudden death, 1; congestive heart failure, 4; myocardial infarction, 1). Patients with an initial AV-Vel Ն5.5 m/s had a higher likelihood (52%) of severe symptom onset (New York Heart Association or Canadian Cardiovascular Society class ϾII) than those with an AV-Vel between 5.0 and 5.5 m/s (27%; Pϭ0.03). 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. (Circulation. 2010;121:151-156.)
