title: When and how aortic stenosis is first diagnosed: A single-center observational study.
abstract: The development of clinical symptoms is associated with cardiovascular events in patients with aortic stenosis (AS). Thus, early diagnosis of AS is clinically important. However, there are few data on symptom status or the severity of AS when patients are first diagnosed, or on how AS is detected in routine practice. We aimed to investigate when and how AS patients are first diagnosed in our hospital.
  
  
  
  We retrospectively enrolled 198 AS patients diagnosed from 1989 to 2009, and identified their symptoms and AS severity at the time of the first diagnosis. We also assessed the reasons why they came to the hospital based on their medical records.
  
  
  
  Of the 198 patients, 82 (41.6%) had voluntarily visited or been referred to our hospital after developing clinical symptoms (Symptomatic group). The remaining 116 patients (58.4%) had been asymptomatic, and cardiovascular disease was suspected during an annual or occasional health checkup (Asymptomatic group). The initial findings in the Asymptomatic group that led to the diagnosis of AS were: a systolic murmur on auscultation (62%), abnormal electrocardiography (27%), or abnormal echocardiography (11%). The Symptomatic group had significantly greater AS severity and an increased left ventricular mass index, and experienced more cardiac events (valve replacement or cardiac death) during the follow-up period.
  
  
  
  About 40% of the AS patients in this study were not diagnosed until they developed clinical symptoms, suggesting that many other patients in the community might have a latent risk of cardiovascular events. Auscultation plays an important role in the early diagnosis of AS.
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei, Medical University, Taipei, Taiwan.
authors.forename: Shuo-Ju
authors.initials: SJ
authors.lastname: Chiang
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan. Electronic address: daimon@muf.biglobe.ne.jp.
authors.forename: Masao
authors.initials: M
authors.lastname: Daimon
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Sakiko
authors.initials: S
authors.lastname: Miyazaki
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kawata
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Ryoko
authors.initials: R
authors.lastname: Morimoto-Ichikawa
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Maruyama
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Ohmura
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Katsumi
authors.initials: K
authors.lastname: Miyauchi
authors.affiliation: Department of Cardiovascular Medicine, the University of Tokyo Hospital, Tokyo, Japan.
authors.forename: Seitetsu L
authors.initials: SL
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000601:surgery; D058070:Asymptomatic Diseases; D042241:Early Diagnosis; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006326:Heart Auscultation; D006337:Heart Murmurs / Q000175:diagnosis; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology; D008297:Male; D012189:Retrospective Studies
keywords: Aortic stenosis; Auscultation; Diagnosis; Symptom; Valve