Outcome of adults with asymptomatic severe aortic stenosis.
OBJECTIVE
To evaluate clinical and echocardiographic variables that could be used to predict outcomes in patients with asymptomatic severe aortic valve stenosis. Management of asymptomatic severe aortic stenosis is controversial. Because prophylactic surgery may be protective, independent predictors of events that could justify early surgery have been sought.


METHODS
Outpatients (n=133; mean [+/-SD] age, 66.2+/-13.6 years) with isolated severe asymptomatic aortic stenosis but normal left ventricular function and no previous myocardial infarction were followed up prospectively at a tertiary care hospital.


METHODS
We use a "wait-for-events" strategy. Clinical and echocardiographic variables were analyzed.


RESULTS
Nineteen patients developed angina; 40, dyspnea; 5, syncope; and 7, sudden death during a mean follow-up period of 3.30+/-1.87 years. Event-free survival was 90.2+/-2.6% at 1 year, 73.4+/-3.9% at 2 years, 70.7+/-4.3% at 3 years, 57.8+/-4.7% at 4 years, 40.3+/-5.0% at 5 years, and 33.3+/-5.2% at 6 years. The mean follow-up period until sudden death (1.32+/-1.11 years) was shorter than that for dyspnea (2.44+/-1.84 years), syncope (2.87+/-1.26 years) and angina (3.03+/-1.68 years). Cox regression analysis disclosed only reduced but within normal limits ejection fraction as independent predictor of total events.


CONCLUSIONS
Management on "wait-for-events" strategy is generally safe. Progressive left ventricular ejection fraction reduction even within normal limits identified patients at high risk for events in whom valve replacement surgery should be considered.
Avakian
Solange D
SD
Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
Grinberg
Max
M
Ramires
José A F
JA
Mansur
Antonio P
AP
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery; D006328:Cardiac Catheterization; D015331:Cohort Studies; D017023:Coronary Angiography; D016757:Death, Sudden, Cardiac; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D011237:Predictive Value of Tests; D011336:Probability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome