on June 13, 2005
Circulation. 2005
Published online before print June 13, 2005, doi: 10.1161/CIRCULATIONAHA.104.495903
Published online before print June 13, 2005, doi: 10.1161/CIRCULATIONAHA.104.495903
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Submitted on July 29, 2004
From the Division of Cardiovascular Diseases (P.A.P., M.E.S., R.A.N., J.F.M., M.E.B., A.J.T.) and the Division of Biostatistics (K.R.B., C.G.S.), Mayo Clinic and Mayo Foundation, Rochester, Minn. * To whom correspondence should be addressed. E-mail: pellikka.patricia{at}mayo.edu.
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 Conclusions--Most patients with asymptomatic, hemodynamically significant AS will develop symptoms within 5 years. Sudden death occurs in
Revised on February 23, 2005
Accepted on March 4, 2005
Outcome of 622 Adults With Asymptomatic, Hemodynamically Significant Aortic Stenosis During Prolonged Follow-Up
Patricia A. Pellikka MD*,
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).
1%/y. Age, chronic renal failure, inactivity, and aortic valve velocity are independently predictive of all-cause mortality.
Key words: echocardiography • surgery • survival • valves • aortic stenosis
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|
|
|
|
 |
|
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|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
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|
|
|
|
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|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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