title: Natural history of very severe aortic stenosis.
abstract: BACKGROUND
  We sought to assess the outcome of asymptomatic patients with very severe aortic stenosis.
  
  
  RESULTS
  We prospectively followed 116 consecutive asymptomatic patients (57 women; age, 67 + or - 16 years) with very severe isolated aortic stenosis defined by a peak aortic jet velocity (AV-Vel) > or = 5.0 m/s (average AV-Vel, 5.37 + or - 0.35 m/s; valve area, 0.63 + or - 0.12 cm(2)). During a median follow-up of 41 months (interquartile range, 26 to 63 months), 96 events occurred (indication for aortic valve replacement, 90; cardiac deaths, 6). Event-free survival was 64%, 36%, 25%, 12%, and 3% at 1, 2, 3, 4, and 6 years, respectively. AV-Vel but not aortic valve area was shown to independently affect event-free survival. Patients with an AV-Vel > or = 5.5 m/s had an event-free survival of 44%, 25%, 11%, and 4% at 1, 2, 3, and 4 years, respectively, compared with 76%, 43%, 33%, and 17% for patients with an AV-Vel between 5.0 and 5.5 m/s (P<0.0001). Six cardiac deaths occurred in previously asymptomatic patients (sudden death, 1; congestive heart failure, 4; myocardial infarction, 1). Patients with an initial AV-Vel > or = 5.5 m/s had a higher likelihood (52%) of severe symptom onset (New York Heart Association or Canadian Cardiovascular Society class >II) than those with an AV-Vel between 5.0 and 5.5 m/s (27%; P=0.03).
  
  
  CONCLUSIONS
  Despite being asymptomatic, patients with very severe aortic stenosis have a poor prognosis with a high event rate and a risk of rapid functional deterioration. Early elective valve replacement surgery should therefore be considered in these patients.
authors.affiliation: Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. raphael.rosenhek@meduniwien.ac.at
authors.forename: Raphael
authors.initials: R
authors.lastname: Rosenhek
authors.forename: Robert
authors.initials: R
authors.lastname: Zilberszac
authors.forename: Michael
authors.initials: M
authors.lastname: Schemper
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.forename: Gerald
authors.initials: G
authors.lastname: Mundigler
authors.forename: Senta
authors.initials: S
authors.lastname: Graf
authors.forename: Jutta
authors.initials: J
authors.lastname: Bergler-Klein
authors.forename: Michael
authors.initials: M
authors.lastname: Grimm
authors.forename: Harald
authors.initials: H
authors.lastname: Gabriel
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D002423:Cause of Death; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index