Outcomes in asymptomatic, severe aortic stenosis

• Published in: PloS one Vol. 16; no. 4; p. e0249610
• Main Authors: Kvaslerud, Anette Borger, Santic, Kenan, Hussain, Amjad Iqbal, Auensen, Andreas, Fiane, Arnt, Skulstad, Helge, Aaberge, Lars, Gullestad, Lars, Broch, Kaspar
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 07.04.2021; PLOS; Public Library of Science (PLoS)
• Subjects: Aged; Aged, 80 and over; Aorta; Aortic stenosis; Aortic valve stenosis; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - pathology; Aortic Valve Stenosis - therapy; Asymptomatic; Asymptomatic Diseases - mortality; Asymptomatic Diseases - therapy; Biology and Life Sciences; Blood pressure; Cardiology; Cardiovascular diseases; Care and treatment; Case-Control Studies; Congestive heart failure; Coronary artery disease; Data analysis; Editing; Ejection fraction; Female; Flow velocity; Health risks; Heart diseases; Heart failure; Heart Valve Prosthesis Implantation - mortality; Hospitals; Humans; Hypertension; Male; Medical prognosis; Medical records; Medicine; Medicine and Health Sciences; Methodology; Mortality; Patient outcomes; Patients; Physiological aspects; Population studies; Prognosis; Pulmonary arteries; Pulmonary artery; Research facilities; Retrospective Studies; Severity of Illness Index; Stenosis; Surgery; Survival Rate; Ultrasonic imaging; Ventricle; Norway
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0249610

Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of contemporary patients advised against aortic valve replacement due to a perceived lack of symptoms. We reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec 1st, 2002 and Dec 31st, 2016. Patients who were evaluated by the heart team due to severe aortic stenosis were categorized by treatment strategy. We recorded baseline data, adverse events and survival for the patients characterized as asymptomatic and for 100 age and gender matched patients scheduled for aortic valve replacement. Of 2341 patients who were evaluated for aortic valve replacement due to severe aortic stenosis, 114 patients received conservative treatment due to a lack of symptoms. Asymptomatic patients had higher mortality than patients who had aortic valve replacement, log-rank p<0.001 (mean follow-up time: 4.0 (SD: 2.5) years). Survival at 1, 2 and 3 years for the asymptomatic patients was 88%, 75% and 63%, compared with 92%, 83% and 78% in the matched patients scheduled for aortic valve replacement. 28 (25%) of the asymptomatic patients had aortic valve replacement during follow-up. Age, previous history of coronary artery disease and N-terminal pro B-type natriuretic peptide (NT-proBNP) were predictors of mortality and coronary artery disease and NT-proBNP were predictors of 3-year morbidity in asymptomatic patients. In this retrospective study, asymptomatic patients with severe aortic stenosis who were advised against surgery had significantly higher mortality than patients who had aortic valve replacement.