Outcome of adults with asymptomatic severe aortic stenosis

Objectives To evaluate clinical and echocardiographic variables that could be used to predict outcomes in patients with asymptomatic severe aortic valve stenosis. Management of asymptomatic severe aortic stenosis is controversial. Because prophylactic surgery may be protective, independent predictors of events that could justify early surgery have been sought. Methods Outpatients (n = 133; mean [± SD] age, 66.2 ± 13.6 years) with isolated severe asymptomatic aortic stenosis but normal left ventricular function and no previous myocardial infarction were followed up prospectively at a tertiary care hospital. Interventions We use a “wait-for-events” strategy. Clinical and echocardiographic variables were analyzed. Results Nineteen patients developed angina; 40, dyspnea; 5, syncope; and 7, sudden death during a mean follow-up period of 3.30 ± 1.87 years. Event-free survival was 90.2 ± 2.6% at 1 year, 73.4 ± 3.9% at 2 years, 70.7 ± 4.3% at 3 years, 57.8 ± 4.7% at 4 years, 40.3 ± 5.0% at 5 years, and 33.3 ± 5.2% at 6 years. The mean follow-up period until sudden death (1.32 ± 1.11 years) was shorter than that for dyspnea (2.44 ± 1.84 years), syncope (2.87 ± 1.26 years) and angina (3.03 ± 1.68 years). Cox regression analysis disclosed only reduced but within normal limits ejection fraction as independent predictor of total events. Conclusions Management on “wait-for-events” strategy is generally safe. Progressive left ventricular ejection fraction reduction even within normal limits identified patients at high risk for events in whom valve replacement surgery should be considered.