title: Clinical outcomes in non-surgically managed patients with very severe versus severe aortic stenosis.
abstract: OBJECTIVE
  The management of asymptomatic severe and very severe aortic stenosis (AS) remains unestablished. This study aimed to investigate the clinical outcomes of severe versus very severe AS patients.
  
  
  METHODS
  A single centre, retrospective cohort study.
  
  
  METHODS
  The study retrospectively reviewed 108 conservatively treated patients with severe AS (a maximal jet velocity ≥ 4.0 m/s, or mean aortic pressure gradient (MPG) ≥ 40 mm Hg, or an aortic valve area (AVA) <1.0 cm(2)) and 58 patients with very severe AS (a maximal jet velocity ≥ 5.0 m/s, or MPG ≥ 50 mm Hg or an AVA <0.6 cm(2)). Clinical outcomes were compared between the two groups, considering the existence of symptoms.
  
  
  METHODS
  All-cause mortality and valve-related event, defined by a composite of cardiac death and hospitalisation because of heart failure.
  
  
  RESULTS
  Mean follow-up was 5.5 ± 3.1 years. Fifty-six patients (52%) with severe AS and 20 patients (34%) with very severe AS were asymptomatic. Very severe AS had poorer survival and valve-related event-free survival than severe AS at 3 years (77% vs 88%, p < 0.01; 75% vs 88%, p < 0.001, respectively). In addition, the 3-year survival and valve-related event-free survival of asymptomatic very severe AS were comparable with symptomatic severe AS, but they were significantly worse than asymptomatic severe AS (p < 0.01 and p < 0.001, respectively).
  
  
  CONCLUSIONS
  Surgery should always be considered in very severe AS regardless of symptoms, and particular attention needs to be paid to their extremely poor outcomes.
authors.affiliation: Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan. t-kitai@kcho.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kitai
authors.forename: Satoshi
authors.initials: S
authors.lastname: Honda
authors.forename: Yukikatsu
authors.initials: Y
authors.lastname: Okada
authors.forename: Tomoko
authors.initials: T
authors.lastname: Tani
authors.forename: Kitae
authors.initials: K
authors.lastname: Kim
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Kaji
authors.forename: Natsuhiko
authors.initials: N
authors.lastname: Ehara
authors.forename: Makoto
authors.initials: M
authors.lastname: Kinoshita
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kobori
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamamuro
authors.forename: Toru
authors.initials: T
authors.lastname: Kita
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D002423:Cause of Death / Q000639:trends; D018450:Disease Progression; D018572:Disease-Free Survival; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*