Abstract 14319: The Recent Trend of Natural History and Prognosis in Patients With Symptomatic Severe Aortic Stenosis
Introductions: It is well known that prognosis of symptomatic severe aortic stenosis (AS) is poor; however, main etiology of AS has changed from rheumatic to degenerative. There are few recent data about the natural history of degenerative AS after emerging symptoms, and the data described by Ross J Jr and Braunwald E in 1968 is still used in clinical settings. The natural history of severe degenerative AS should be reevaluated in determining treatment strategy including surgical or transcatheter aortic valve replacement.
Methods: We retrospectively investigated 86 consecutive patents who had aortic valve area (AVA) <1.0cm2 and did not undergo aortic valve replacement despite presenting AS-related symptoms and/or EF<50% from 1999 to 2012. Prognosis after emerging each symptoms and/or EF<50% was examined. Patients were classified according to maximal jet velocity (AVp) and EF: AVp≥5.0m/s; very high pressure gradient (PG) (VHG; n=17), AVp 4.9-4.0m/s; high PG (HG; n=25), AVp<4.0m/s and EF<50%; low PG low EF (LGLEF; n=10), and AVp<4.0m/s and EF>50%; low PG normal EF (LGNEF; n=11).
Results: During a median follow-up of 2.8±2.2 years, cardiac death occurred in 40 patients and non-cardiac death in 24 patients. Heart failure (HF) was shown in 63, syncope in 15, chest pain in 19, and EF<50% in 32 patients. The overall median survival time and 3 year cardiac death-free rate after presenting each symptom or EF<50% were as follows; HF: 2.3 years and 38.9%, syncope: 3.9 years and 54.0%, chest pain: 6.9 years and 81.9%, EF<50%: 3.3 years and 51.1%. Moreover, the median survival time and 3 year cardiac death-free rate after presenting HF was 1.8 years and 37% in VHG, 2.5 years and 46% in HG, 2.5 years and 55% in LGLEF, and 53% in LGNEF, respectively (p>0.05).
Conclusion: The prognosis of severe AS patients with heart failure or low EF was poor, but the prognosis of patients with syncope or chest pain was better than that described in the past. Moreover, patients who once experienced heart failure showed poor prognosis regardless of pressure gradient and EF. Taking into account these results of the natural history of severe degenerative AS, we should discuss the risk-benefit for treatment strategy.
Author Disclosures: M. Amano: None. C. Izumi: None. Y. Obayashi: None. M. Fuki: None. M. Imanaka: None. S. Nishimura: None. M. Kuroda: None. S. Imamura: None. N. Onishi: None. J. Sakamoto: None. Y. Tamaki: None. S. Enomoto: None. M. Miyake: None. T. Tamura: None. H. Kondo: None. K. Kaitani: None. Y. Nakagawa: None.
- © 2016 by American Heart Association, Inc.