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Asymptomatic versus Symptomatic Patients with Severe Aortic Stenosis
Norio Kanamori1, Tomohiko Taniguchi2, Takeshi Morimoto3
1Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan.
Scientific Reports
|July 6, 2018
Summary
Symptomatic patients with severe aortic stenosis (AS) face a significantly higher risk of aortic valve-related death or heart failure hospitalization compared to asymptomatic patients. Optimal aortic valve replacement (AVR) rates in symptomatic individuals remain a concern.
Area of Science:
- Cardiology
- Clinical Outcomes Research
- Valvular Heart Disease
Background:
- Severe aortic stenosis (AS) poses a significant clinical challenge, with unclear differences in outcomes between symptomatic and asymptomatic patients.
- Understanding long-term prognoses is crucial for guiding treatment decisions in severe AS.
Purpose of the Study:
- To compare the long-term clinical outcomes of asymptomatic versus symptomatic patients diagnosed with severe aortic stenosis (AS).
- To evaluate the impact of symptoms on mortality and heart failure hospitalization in severe AS patients.
Main Methods:
- Analysis of the CURRENT AS registry data, including 3,815 patients with severe AS.
- Comparison of outcomes between 1808 asymptomatic and 1215 symptomatic patients (exertional dyspnea, syncope, angina) without prior heart failure hospitalization.
- Long-term follow-up assessing aortic valve replacement (AVR) rates and a composite outcome of aortic valve-related death or heart failure hospitalization.
Main Results:
- Symptomatic patients exhibited greater AS severity and reduced left ventricular function compared to asymptomatic counterparts.
- The 5-year cumulative incidence of the primary outcome (aortic valve-related death or HF hospitalization) was higher in symptomatic patients (32.3%) than asymptomatic patients (27.6%).
- Adjusted analysis revealed a significantly greater risk for the primary outcome in symptomatic versus asymptomatic patients (HR 1.64).
Conclusions:
- Symptomatic patients with severe AS have a significantly higher risk of adverse aortic valve-related events compared to asymptomatic patients.
- The observed rate of aortic valve replacement (AVR) in symptomatic severe AS patients was suboptimal, indicating a potential gap in timely intervention.
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