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The natural history of adults with asymptomatic, hemodynamically significant aortic stenosis

P A Pellikka1, R A Nishimura, K R Bailey

  • 1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.

Journal of the American College of Cardiology
|April 1, 1990
PubMed

Insights

Asymptomatic severe aortic stenosis patients who delay intervention face a significant risk of cardiac events. Higher Doppler flow velocity predicts adverse outcomes in these adults.

Area of Science:

  • Cardiology
  • Echocardiography
  • Clinical Medicine

Background:

  • Valvular aortic stenosis (AS) is a common heart valve disease.
  • Asymptomatic severe AS requires understanding its natural history.
  • Hemodynamic significance is defined by Doppler echocardiography (peak systolic flow velocity ≥ 4 m/s).

Purpose of the Study:

  • To document the natural history of asymptomatic, hemodynamically significant, valvular aortic stenosis in adults.
  • To identify predictors of cardiac events in this patient cohort.

Main Methods:

  • Retrospective analysis of 471 patients with AS identified by Doppler echocardiography (1984-1987).
  • Focus on 143 asymptomatic patients with isolated valvular AS.
  • Comparison of outcomes between 30 patients undergoing early intervention (group 1) and 113 not undergoing early intervention (group 2).
  • Follow-up duration averaged 20 months.

Main Results:

  • Group 1 (early intervention): 3 cardiac events post-operation (2 deaths, 1 reoperation).
  • Group 2 (delayed intervention): 3 cardiac deaths (presumed AS-related), all symptomatic prior to death.
  • Actuarial probability of remaining symptom-free in group 2 was 86% at 1 year and 62% at 2 years.
  • Actuarial probability of remaining event-free (intervention or death) in group 2 was 93% at 1 year and 74% at 2 years.
  • Doppler flow velocity and ejection fraction were independent predictors of cardiac events in group 2.
  • Patients with flow velocity ≥ 4.5 m/s had a 4.9-fold increased risk of cardiac events.

Conclusions:

  • Asymptomatic severe valvular aortic stenosis carries a significant risk of cardiac events and death.
  • Delayed intervention in asymptomatic severe AS patients is associated with predictable adverse outcomes.
  • Doppler flow velocity is a critical factor in assessing the risk of cardiac events in severe AS.

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