Natural history of aortic valve stenosis of varying severity in the elderly

Iivanainen, A. M.; Lindroos, Magnus; Tilvis, Reijo S.; Heikkilä, J; Kupari, Markku

doi:10.1016/s0002-9149(96)00235-4

Cited by 150 publications

(74 citation statements)

References 18 publications

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“…At 4-year follow-up of patients aged 75 to 86 years in the Helsinki Aging Study, the incidence of cardiovascular mortality was 62% in patients with severe AS [2]. At 4-year follow-up, the incidence of total mortality was 76% in patients with severe AS [2].…”

Section: Editorialmentioning

confidence: 97%

“…At the National Institutes of Health, 52% of patients with symptomatic severe valvular AS not operated on were dead at 5 years [1]. At 10-year followup, 90% of these patients were dead.At 4-year follow-up of patients aged 75 to 86 years in the Helsinki Aging Study, the incidence of cardiovascular mortality was 62% in patients with severe AS [2]. At 4-year follow-up, the incidence of total mortality was 76% in patients with severe AS [2].…”

mentioning

confidence: 97%

“…The average survival rate after the onset of heart failure in patients with severe AS was 1.5 to 2 years [1]. Patients with symptomatic severe valvular AS have a poor prognosis [1][2][3][4]. At the National Institutes of Health, 52% of patients with symptomatic severe valvular AS not operated on were dead at 5 years [1].…”

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confidence: 99%

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Indications for Surgical Aortic Valve Replacement

Aronow¹

2013

J Cardiovasc Dis Diagn

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EditorialOpen AccessThe average survival rate was 3 years after the onset of angina pectoris in patients with severe Aortic Stenosis (AS) [1]. The average survival rate after the onset of syncope in patients with severe AS was 3 years [1]. The average survival rate after the onset of heart failure in patients with severe AS was 1.5 to 2 years [1]. Patients with symptomatic severe valvular AS have a poor prognosis [1][2][3][4]. At the National Institutes of Health, 52% of patients with symptomatic severe valvular AS not operated on were dead at 5 years [1]. At 10-year followup, 90% of these patients were dead.At 4-year follow-up of patients aged 75 to 86 years in the Helsinki Aging Study, the incidence of cardiovascular mortality was 62% in patients with severe AS [2]. At 4-year follow-up, the incidence of total mortality was 76% in patients with severe AS [2].In a prospective study, at 19-month follow-up (range 2 to 36 months), 90% of 30 patients with heart failure associated with unoperated severe AS and a normal left ventricular ejection fraction were dead [3]. At 13-month follow-up (range 2 to 24 months), 100% of 18 patients with heart failure associated with unoperated severe AS and an abnormal left ventricular ejection fraction were dead [3]. In a prospective study, at 20-month follow-up of 40 elderly patients with severe AS, heart failure, syncope, or angina pectoris was present in 36 of 37 patients (97%) who developed new coronary events and in none of 3 patients (0%) without new coronary events [4].Surgical Aortic Valve Replacement (AVR) is the procedure of choice for symptomatic patients with severe AS (an aortic valve area less than 1.0 cm 2 ) with a Class I indication [5]. Other Class I indications for AVR in patients with severe AS include 2) patients undergoing coronary artery bypass graft surgery, 3) patients undergoing surgery on the aorta or other heart valves, and 4) patients with a left ventricular ejection fraction less than 50% [5]. Patients with moderate AS undergoing coronary artery bypass graft surgery or surgery on the aorta or other heart valves have a Class IIa indication for AVR [5].Although the American College of Cardiology/American Heart Association guidelines does not recommend AVR in patients with asymptomatic severe AS and normal left ventricular ejection fraction, there are data suggesting otherwise [6][7][8][9][10]. Pai et al. [6] found in their database that 99 of 338 patients (29%) mean age 71 years, with asymptomatic severe AS had AVR during 3.5-year follow-up. Survival at 1, 2, and 5 years was 67%, 56%, and 38%, respectively for nonoperated patients and 94%, 93%, and 90%, respectively for those who had AVR. In the unoperated group, beta blocker use significantly reduced mortality by 48%, and statin use significantly reduced mortality by 48% [6].Severe asymptomatic AS was present in 622 patients, mean age 72 years, at the Mayo Clinic [7]. Of the 622 patients, 166 (27%) developed symptoms and had AVR. Another 97 patients (16%) had AVR in the absence of symptoms. At 3-year fol...

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Section: Editorialmentioning

confidence: 97%

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confidence: 97%

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Indications for Surgical Aortic Valve Replacement

Aronow¹

2013

J Cardiovasc Dis Diagn

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“…Indeed, far from being contraindicated on 'first principles', current knowledge of the role of the reninangiotensin system in aortic stenosis would suggest that these drugs may be highly advantageous to patients with this valve lesion. Currently, no medical therapy is known to influence the natural history of aortic stenosis, a disorder that affects up to 10% of the elderly population 3 and which without surgery inevitably results in premature death. …”

Section: Introductionmentioning

confidence: 99%

ACE inhibition in aortic stenosis: dangerous medicine or golden opportunity?

Routledge

Townend

2001

J Hum Hypertens

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Conventionally angiotensin-converting enzyme (ACE) inhibitors are contraindicated in patients with aortic stenosis. Abundant evidence is now available showing that angiotensin II has a central role in the development of left ventricular hypertrophy (LVH), myocardial contractile failure and diastolic dysfunction in response to pressure overload. In animal models, ACE inhibitors have been shown to attenuate these pathological responses. In humans there is no such evidence available, however uncontrolled studies have shown that

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“…P atients with valvular aortic stenosis have a higher prevalence of coronary artery disease (1-3) and a higher incidence of new coronary events (3,4) than patients without valvular aortic stenosis. Patients with mitral annular calcium (MAC) have a higher prevalence of coronary artery disease (2,5) and a higher incidence of new coronary events (6,7) than patients without MAC.…”

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confidence: 99%

Patients with echocardiographic aortic valve calcium or mitral annular calcium have an increased prevalence of moderate or severe coronary artery calcium diagnosed by cardiac computed tomography

Kaplan

Aronow²,

Lai³

et al. 2007

Int J Angiol

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The association between aortic valve calcium (AVC) and mitral annular calcium (MAC), as diagnosed by two-dimensional echocardiography, was investigated in 138 patients (76 women and 62 men, mean age 64±8 years) seen in a private cardiology practice at the New York Medical College. Coronary artery calcium (CAC) scores were diagnosed by 64-multislice computed tomography. AVC was present in 25 of 57 patients (44%) with moderate or severe CAC (a CAC score of more than 100) and in 15 of 81 patients (19%) with no or mild CAC (a CAC score of 0 to 100), P<0.001. Moderate or severe AVC was present in nine of 57 patients (16%) with moderate or severe CAC, and in two of 81 patients (2%) with no or mild CAC, P<0.005. MAC was present in 18 of 57 patients (32%) with moderate or severe CAC, and in seven of 81 patients (9%) with no or mild CAC, P<0.001. Moderate or severe MAC was present in eight of 57 patients (14%) with moderate or severe CAC, and in two of 81 patients (2%) with no or mild CAC, P<0.001.

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Natural history of aortic valve stenosis of varying severity in the elderly

Cited by 150 publications

References 18 publications

Indications for Surgical Aortic Valve Replacement

Indications for Surgical Aortic Valve Replacement

ACE inhibition in aortic stenosis: dangerous medicine or golden opportunity?

Patients with echocardiographic aortic valve calcium or mitral annular calcium have an increased prevalence of moderate or severe coronary artery calcium diagnosed by cardiac computed tomography

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