Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up

Background - This study assessed the long- term outcome of a large, asymptomatic population with hemodynamically significant aortic stenosis ( AS). Methods and Results - We identified 622 patients with isolated, asymptomatic AS and peak systolic velocity >= 4 m/ s by Doppler echocardiography who did not undergo surgery at the initial evaluation and obtained follow- up ( 5.4 +/- 4.0 years) in all. Mean age ( +/- SD) was 72 +/- 11 years; there were 384 ( 62%) men. The probability of remaining free of cardiac symptoms while unoperated was 82%, 67%, and 33% at 1, 2, and 5 years, respectively. Aortic valve area and left ventricular hypertrophy predicted symptom development. During follow- up, 352 ( 57%) patients were referred for aortic valve surgery and 265 ( 43%) patients died, including cardiac death in 117 ( 19%). The 1-, 2-, and 5- year probabilities of remaining free of surgery or cardiac death were 80%, 63%, and 25%, respectively. Multivariate predictors of all- cause mortality were age ( hazard ratio [ HR], 1.05; P < 0.0001), chronic renal failure ( HR, 2.41; P = 0.004), inactivity ( HR, 2.00; P = 0.001), and aortic valve velocity ( HR, 1.46; P = 0.03). Sudden death without preceding symptoms occurred in 11 ( 4.1%) of 270 unoperated patients. Patients with peak velocity >= 4.5 m/ s had a higher likelihood of developing symptoms ( relative risk, 1.34) or having surgery or cardiac death ( relative risk, 1.48). Conclusions - Most patients with asymptomatic, hemodynamically significant AS will develop symptoms within 5 years. Sudden death occurs in approximate to 1%/ y. Age, chronic renal failure, inactivity, and aortic valve velocity are independently predictive of all- cause mortality.