Untreated Severe Aortic Stenosis Yields Poor Prognosis

Patients with untreated severe aortic stenosis had poor prognosis and survival rates, a new analysis confirms.

“Historical data suggesting poor survival in patients with aortic stenosis (AS) who do not undergo treatment are largely confined to patients with severe aortic stenosis,” the study authors wrote. “This study sought to determine the prognostic impact of all levels of native valvular aortic stenosis.”

The study included 122,809 male patients and 118,494 female patients with measured aortic valve mean gradient, peak velocity, and/or area. The authors examined the relationship between aortic stenosis severity and survival during a median follow-up of 1,208 days. A total of 16,129 (6.7%) patients had mild, 3,315 (1.4%) had moderate, and 6,383 (2.6%) had severe stenosis. The researchers excluded patients with previous aortic valve interventions. The results of this study were published in the Journal of the American College of Cardiology.

According to the results, after adjustment, patients with mild and severe aortic stenosis had an increased long-term mortality risk (adjusted HR=1.44 to 2.09; P<0.001 for all comparisons). Compared to those without stenosis (19%), patients with moderate (mean gradient 20.0 to 39.0 mm Hg; peak velocity 3.0 to 3.9 m/s) and severe stenosis (≥40.0 mm Hg, ≥4.0 m/s, or AV area <1.0 cm² in low-flow, low-gradient)) had mortality rates of 56% and 67%, respectively.

“These data confirm that when left untreated, severe aortic stenosis is associated with poor long-term survival,” the researchers wrote in their conclusion. “Moreover, they also suggest poor survival rates in patients with moderate aortic stenosis.”

Poor long term survival in patients with moderate aortic stenosis https://t.co/IvXVdsQJCV

— Su Hnin Hlaing (@suhninhlaing) October 4, 2019

This is the new critical question. https://t.co/ieHj1P5WA7

— Guy Lloyd (@guyll) September 12, 2019

Poor Long-term Survival in Patients with Moderate Aortic Stenosis. https://t.co/ST9Y0dLiSj

— Baker Institute OAR (@BakerResOAR) September 7, 2019

TAVR-UNLOAD is a very difficult but critically important trial. It’s hard to randomize medically-refractory moderate MS patients between TAVR vs. GDMT, but these are most likely the moderate AS patients who stand to benefit most from TAVR! https://t.co/ooMHmjwcVM

— Andrew M. Goldsweig, MD, MS (@AGoldsweig) September 6, 2019

Poor Long-Term Survival in Patients With Moderate #Aortic #Stenosis – do we have to consider referring these patients to valve replacement therapy sooner?https://t.co/EPy3rmtloU #ACCIC #ACCFIT #AHAEarlyCareer #ACCEarlyCareer #TCT2019 pic.twitter.com/PAnWyLJxGw

— Chadi Alraies, MD FACC FSCAI (@chadialraies) September 11, 2019