Journal Article

Symptoms, disease severity and treatment of adults with a new diagnosis of severe aortic stenosis

Serra, Antonio, Thambyrajah, Jeetendra, Rieber, Johannes, Belle, Loic, Arnold, Martin, Lauten, Alexander, Lutz, Matthias, Delle Karth, Georg, Bouma, Berto J, Maly, Jiri, Lloyd, Guy, Thoenes, Martin, Messika-Zeitoun, David, Indorfi, Ciro, Steeds, Richard Paul, Frey, Norbert, Clerici, Alberto, Kurucova, Jana, Schulz, Eberhard, Aiello, Marco, Pohlmann, Christiane, Hauptmann, Karl Eugen, Bramlage, Peter, Rudolph, Tanja K, Bortone, Alessandro Santo, Mancone, Massimo

2019

Overview

ObjectiveContemporary data on patients with previously undiagnosed severe aortic stenosis (AS) are scarce. We aimed to address this gap by gathering data from consecutive patients diagnosed with severe AS on echocardiography.MethodsThis was a prospective, multicentre, multinational, registry in 23 tertiary care hospitals across 9 European countries. Patients with a diagnosis of severe AS were included using echocardiography (aortic valve area (AVA) <1 cm2, indexed AVA <0.6 cm2/m2, maximum jet-velocity (Vmax) >4 m/s and/or mean transvalvular gradient >40 mm Hg).ResultsThe 2171 participants had a mean age of 77.9 years and 48.0% were female. The mean AVA was 0.73 cm2, Vmax4.3 m/s and mean gradient 47.1 mm Hg; 62.1% had left ventricular hypertrophy and 27.3% an ejection fraction (EF) <50%. 1743 patients (80.3%) were symptomatic (shortness-of-breath 91.0%; dizziness 30.2%, chest pain 28.9%). Patients had a EuroSCORE II of 4.0; 25.3% had a creatinine clearance <50 mL/min, and 3.2% had an EF <30%. Symptomatic patients were older and had more comorbidities than asymptomatic patients. Despite European Society of Cardiology 2017 valvular heart disease guideline class I recommendation, in only 76.2% a decision was made for an intervention (transcatheter 50.4%, surgical aortic valve replacement 25.8%). In asymptomatic patients, 57.7% with a class I/IIa indication were scheduled for a procedure, while 36.3% patients without an indication had their valve replaced.ConclusionsThe majority of patients with severe AS presented at an advanced disease stage. Management of severe AS remained suboptimal in a significant proportion of contemporary patients with severe AS.Trial registration numberNCT02241447;Results.

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group LTD
• Subject: Activities of daily living / Aortic stenosis / Asymptomatic / Body mass index / Cardiology / Cardiovascular disease / Comorbidity / Ejection fraction / Electrocardiography / Family medical history / Frailty / Heart / Medical prognosis / Patients / Pulmonary arteries / Surgery / surgical aortic valve replacement / symptoms / Thoracic surgery / transcatheter aortic valve replacement / Valvular heart disease