title: Clinical course of patients diagnosed with severe aortic stenosis in the Rotterdam area: insights from the AVARIJN study.
abstract: OBJECTIVE
  To prospectively evaluate the clinical course of patients with severe aortic stenosis (AS) and identify factors associated with treatment selection and patient outcome.
  
  
  METHODS
  Patients diagnosed with severe AS in the Rotterdam area were included between June 2006 and May 2009. Patient characteristics, echocardiogram, brain natriuretic peptide (NT-proBNP), and treatment strategy were assessed at baseline, and after 6, 12, and 24 months. Endpoints were aortic valve replacement (AVR) / transcatheter aortic valve implantation (TAVI) and death.
  
  
  RESULTS
  The study population comprised 191 patients, 132 were symptomatic and 59 asymptomatic at study entry. Two-year cumulative survival of symptomatic patients was 89.8 % (95 % CI 79.8-95.0 %) after AVR/TAVI and 72.6 % (95 % CI 59.7-82.0 %) with conservative treatment. Two-year cumulative survival of asymptomatic patients was 91.5 % (95 % CI 80.8-96.4 %). Two-year cumulative incidence of AVR/TAVI was 55.9 % (95 % CI 47.5-63.5 %) in symptomatic patients. Sixty-eight percent of asymptomatic patients developed symptoms, median time to symptoms was 13 months; AVR/TAVI cumulative incidence was 38.3 % (95 % CI 23.1-53.3 %). Elderly symptomatic patients with multiple comorbidities were more likely to receive conservative treatment.
  
  
  CONCLUSIONS
  In contemporary Dutch practice many symptomatic patients do not receive invasive treatment of severe AS. Two-thirds of asymptomatic patients develop symptoms within 2 years, illustrating the progressive nature of severe AS. Treatment optimisation may be achieved through careful individualised assessment in a multidisciplinary setting.
authors.affiliation: Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands, h.heuvelman@erasmusmc.nl.
authors.forename: H J
authors.initials: HJ
authors.lastname: Heuvelman
authors.forename: M W A
authors.initials: MW
authors.lastname: van Geldorp
authors.forename: A P
authors.initials: AP
authors.lastname: Kappetein
authors.forename: M L
authors.initials: ML
authors.lastname: Geleijnse
authors.forename: T W
authors.initials: TW
authors.lastname: Galema
authors.forename: A J J C
authors.initials: AJ
authors.lastname: Bogers
authors.forename: J J M
authors.initials: JJ
authors.lastname: Takkenberg