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(Circulation. 2009;120:9-11.)
© 2009 American Heart Association, Inc.

Editorial

Predicting Outcome in Patients With Asymptomatic Aortic Stenosis

Erin E. Coglianese, MD; Ravin Davidoff, MBBCh

From the Evans Department of Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Mass.

Correspondence to Dr Ravin Davidoff, Boston Medical Center, Division of Cardiology, 85 E Concord St, Boston, MA 02118. E-mail ravin.davidoff@bmc.org

Key Words: Editorials • natriuretic peptides • valves

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Although the annual risk of cardiovascular mortality has been well described for individuals with symptomatic aortic stenosis, the morbidity and mortality for those with asymptomatic severe aortic stenosis is not as well known. Currently the American Heart Association/American College of Cardiology recommends a "watchful waiting" strategy for those with asymptomatic aortic stenosis.¹ This involves clinical examinations every 6 to 12 months and annual echocardiograms; however, it is unclear what to do with these data in the patient who remains asymptomatic. The asymptomatic patient is generally not referred for aortic valve replacement surgery until the development of symptoms (unless concurrent coronary artery bypass grafting is required or if systolic dysfunction develops).

Article see p 69

Approximately 30% of asymptomatic patients will develop symptoms (angina, heart failure, syncope) within 2 years of diagnosis.^2,3 For those patients who do not develop symptoms, the risk of sudden cardiac death is less than 1% per year, assuming that patients are well monitored for the development of symptoms.^2,3 Although angina and syncope are relatively easy symptoms to elicit, manifestations of heart failure may be subtle. This is particularly true because many of these patients are elderly and attribute reduced exercise capacity to be part of the normal aging process or "slowing down." Vigilance and careful attention to a patient’s history are important components of the regular evaluation of patients with aortic stenosis. However, even careful attention to the history may not predict sudden death in patients with severe aortic stenosis. The reluctance to perform surgery earlier . . . [Full Text of this Article]

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