Asymptomatic versus Symptomatic Patients with Severe Aortic Stenosis

Abstract

It is unknown how much different are the clinical outcomes between asymptomatic and symptomatic patients with severe aortic stenosis (AS). In the CURRENT AS registry enrolling 3,815 consecutive patients with severe AS, we compared the long-term outcomes between 1808 asymptomatic and 1215 symptomatic patients (exertional dyspnea: N = 813, syncope: N = 136, and angina: N = 266) without heart failure (HF) hospitalization. Symptomatic patients had greater AS severity, and more depressed left ventricular function than asymptomatic patients without much difference in other baseline characteristics. During a median follow-up of 3.2 years, aortic valve replacement (AVR) was performed in 62% of symptomatic patients, and 38% of asymptomatic patients. The cumulative 5-year incidences for the primary outcome measure (a composite of aortic valve-related death or HF hospitalization) was higher in symptomatic patients than in asymptomatic patients (32.3% versus 27.6%, P < 0.001). After adjusting for AVR and other variables, the greater risk of symptomatic relative to asymptomatic patients for the primary outcome measure was significant (hazard ratio 1.64, 95% confidence interval 1.41–1.96, P < 0.001). In conclusions, the excess risk of symptomatic relative to asymptomatic patients with severe AS for the aortic valve-related event was significant. However, the prevalence of AVR in symptomatic patients was not optimal.

Exercise Training for Patients With Severe Aortic Stenosis in a Convalescent Rehabilitation Ward ― A Retrospective Cohort Study ―

“…toms (13.4% vs. 6.6%, respectively). 15 Because respiratory rehabilitation and ROMEs were only performed for Patient 17, we conclude that his death can be attributed to natural causes rather than an excessive exercise load. There is no doubt that the cause of congestive heart failure in Patient 18 was not attributed to our exercise program because the same rehabilitation program was applied to Patient 17.…”

Contemporary issues in severe aortic stenosis: review of current and future strategies from the Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis registry

“…There was no previous large-scale multicentre study assessing the clinical outcomes according to the types of AS-related symptoms in contemporary patients with severe AS. Patients with exertional dyspnoea had significantly higher risk of a composite of aortic valve-related death or HF hospitalisation than those with angina, while the risk of a composite of aortic valve-related death or HF hospitalisation was not significantly different between patients with syncope and those with angina 24. More importantly, management of patients with AHF requiring hospitalisation is particularly challenging.…”