title: Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up.
abstract: BACKGROUND
  This study assessed the long-term outcome of a large, asymptomatic population with hemodynamically significant aortic stenosis (AS).
  
  
  RESULTS
  We identified 622 patients with isolated, asymptomatic AS and peak systolic velocity > or =4 m/s by Doppler echocardiography who did not undergo surgery at the initial evaluation and obtained follow-up (5.4+/-4.0 years) in all. Mean age (+/-SD) was 72+/-11 years; there were 384 (62%) men. The probability of remaining free of cardiac symptoms while unoperated was 82%, 67%, and 33% at 1, 2, and 5 years, respectively. Aortic valve area and left ventricular hypertrophy predicted symptom development. During follow-up, 352 (57%) patients were referred for aortic valve surgery and 265 (43%) patients died, including cardiac death in 117 (19%). The 1-, 2-, and 5-year probabilities of remaining free of surgery or cardiac death were 80%, 63%, and 25%, respectively. Multivariate predictors of all-cause mortality were age (hazard ratio [HR], 1.05; P<0.0001), chronic renal failure (HR, 2.41; P=0.004), inactivity (HR, 2.00; P=0.001), and aortic valve velocity (HR, 1.46; P=0.03). Sudden death without preceding symptoms occurred in 11 (4.1%) of 270 unoperated patients. Patients with peak velocity > or =4.5 m/s had a higher likelihood of developing symptoms (relative risk, 1.34) or having surgery or cardiac death (relative risk, 1.48).
  
  
  CONCLUSIONS
  Most patients with asymptomatic, hemodynamically significant AS will develop symptoms within 5 years. Sudden death occurs in approximately 1%/y. Age, chronic renal failure, inactivity, and aortic valve velocity are independently predictive of all-cause mortality.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic and Mayo Foundation, Rochester, Minn 55905, USA. pellikka.patricia@mayo.edu
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.forename: Maurice E
authors.initials: ME
authors.lastname: Sarano
authors.forename: Rick A
authors.initials: RA
authors.lastname: Nishimura
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Malouf
authors.forename: Kent R
authors.initials: KR
authors.lastname: Bailey
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Scott
authors.forename: Marion E
authors.initials: ME
authors.lastname: Barnes
authors.forename: A Jamil
authors.initials: AJ
authors.lastname: Tajik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D002423:Cause of Death; D003645:Death, Sudden; D018450:Disease Progression; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D017379:Hypertrophy, Left Ventricular; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate