Predictors of Outcome in Severe, Asymptomatic Aortic Stenosis

Rosenhek, Raphaël; Binder, Thomas; Porenta, Gerold; Lang, Irene M.; Christ, Guenter; Schemper, M.; Maurer, Gerald; Baumgartner, Helmut

doi:10.1056/nejm200008313430903

Cited by 1,159 publications

(519 citation statements)

References 29 publications

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“…Indeed, recent projections from The OxVALVE population cohort study25 suggest that the number of elderly people with moderate or severe valvular heart disease in the United Kingdom alone will more than double by 2056, from 1.5 to 3.3 million people. AS is the most prevalent valvular disease among older adults in the United States, many of whom are asymptomatic but have a heightened risk of mortality and rapid disease progression 26, 27. Our estimate of the prevalence of aortic sclerosis or stenosis of 20.9% is similar to other cohorts in elderly individuals 28.…”

Section: Discussionsupporting

confidence: 67%

Ideal Cardiovascular Health and the Prevalence and Severity of Aortic Stenosis in Elderly Patients

Sengeløv

Cheng

Biering‐Sørensen

et al. 2018

JAHA

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BackgroundThe relationship between ideal cardiovascular health reflected in the cardiovascular health score (CVHS) and valvular heart disease is not known. The purpose of this study was to determine the association of CVHS attainment through midlife to late life with aortic stenosis prevalence and severity in late life.Methods and ResultsThe following 6 ideal cardiovascular health metrics were assessed in ARIC (Atherosclerosis Risk in Communities) Study participants at 5 examination visits between 1987 and 2013 (visits 1–4 in 1987–1998 and visit 5 in 2011–2013): smoking, body mass index, total cholesterol, blood pressure, physical activity, and blood glucose. Percentage attained CVHS was calculated in 6034 participants as the sum of CVHS at each visit/the maximum possible score. Aortic stenosis was assessed by echocardiography at visit 5 on the basis of the peak aortic valve velocity. Aortic stenosis was categorized sclerosis, mild stenosis, and moderate‐to‐severe stenosis. Mean age was 76±5 years, 42% were men, and 22% were black. Mean percentage attained CVHS was 63±14%, and the prevalence of aortic stenosis stages were 15.9% for sclerosis, 4.3% for mild stenosis, and 0.7% for moderate‐to‐severe stenosis. Worse percentage attained CVHS was associated with higher prevalence of aortic sclerosis (P<0.001 for trend), mild stenosis (P<0.001), and moderate‐to‐severe stenosis (P=0.002), adjusting for age, sex, and race.ConclusionsGreater attainment of ideal cardiovascular health in midlife to late life is associated with a lower prevalence of aortic sclerosis and stenosis in late life in a large cohort of older adults.

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Section: Discussionsupporting

confidence: 67%

Ideal Cardiovascular Health and the Prevalence and Severity of Aortic Stenosis in Elderly Patients

Sengeløv

Cheng

Biering‐Sørensen

et al. 2018

JAHA

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“…It has long been recognized that patients with symptomatic severe AS need to undergo SAVR 25, 26. Although a watchful waiting approach is generally justified in asymptomatic patients with severe AS, there are still concerns about when such a strategy should occur 27. Because improved surgical techniques have led to lower operative mortality and morbidity rates, earlier intervention has been increasingly advocated 3, 4, 5.…”

Section: Discussionmentioning

confidence: 99%

Patients Refusing Transcatheter Aortic Valve Replacement Even Once Have Poorer Clinical Outcomes

Shimura

Yamamoto

Kano

et al. 2018

JAHA

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BackgroundAlthough transcatheter aortic valve replacement (TAVR) is the least invasive treatment for patients with symptomatic aortic stenosis, some patients hesitate to undergo the procedure. We investigated the clinical impact of treatment delay after patient refusal of TAVR.Methods and ResultsWe used the Japanese OCEAN (Optimized Catheter valvular intervention) regsitry data of 1542 patients who underwent TAVR. Refusal was defined as at least 1 refusal of TAVR at the time of informed consent. Patients were separated into 2 groups: refusal (28/1542, 1.8%) and non‐refusal (1514/1542, 98.2%). We compared the baseline characteristics, procedural outcomes, and mortality rates between the groups. Additionally, data on reasons for refusal and those leading to eventually undergoing TAVR were collected. Age, surgical risk scores, and frailty were higher in the refusal group than in the non‐refusal group (P<0.05 for all). Periprocedural complications did not differ between groups, whereas 30‐day and cumulative 1‐year mortality were significantly higher in the refusal group than in the non‐refusal group (7.1% versus 1.3%, P=0.008 and 28.8% versus 10.3%, P=0.010, respectively). Multivariate Cox regression analysis revealed that TAVR refusal was an independent predictor of increased midterm mortality (hazard ratio: 3.37; 95% confidence interval: 1.52–7.48; P=0.003). The most common reason for refusal was fear (13/28, 46.4%), and the most common reason for changing their mind was worsening heart failure (21/28, 75.0%). All patients in the refusal group decided to undergo TAVR within 20 months (median: 5.5 months).ConclusionsRefusing TAVR even once led to poorer prognosis; therefore, this fact should be clearly discussed when obtaining informed consent.

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“…Nevertheless, patients with advanced CKD and ESRD represent a population that is at high risk for rapid progression of AS 20, 99, 100, 101. LVH, reduced LVEF, and PH are all linked to a higher risk of adverse events in patients with AS and are highly prevalent in patients with advanced CKD and ESRD 113, 114, 115, 116. With these considerations in mind, it may be reasonable to correct severe asymptomatic AS prior to renal transplantation with SAVR or TAVR.…”

Section: Valvular Disease In Patients With Esrdmentioning

confidence: 99%

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

Bhatti

Galougahi

Paz

et al. 2016

JAHA

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Predictors of Outcome in Severe, Asymptomatic Aortic Stenosis

Cited by 1,159 publications

References 29 publications

Ideal Cardiovascular Health and the Prevalence and Severity of Aortic Stenosis in Elderly Patients

Ideal Cardiovascular Health and the Prevalence and Severity of Aortic Stenosis in Elderly Patients

Patients Refusing Transcatheter Aortic Valve Replacement Even Once Have Poorer Clinical Outcomes

Diagnosis and Management of Cardiovascular Disease in Advanced and End‐Stage Renal Disease

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