Poor Long-Term Survival in Patients With Moderate Aortic Stenosis

National Echocardiography Database of Australia contributing sites

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Historical data suggesting poor survival in patients with aortic stenosis (AS) who do not undergo treatment are largely confined to patients with severe AS.

    Objectives: This study sought to determine the prognostic impact of all levels of native valvular AS.

    Methods: Severity of AS was characterized by convention and by statistical distribution in 122,809 male patients (mean age 61 ± 17 years) and 118,494 female patients (mean age 62 ± 19 years), with measured aortic valve (AV) mean gradient, peak velocity, and/or area. The relationship between AS severity and survival was then examined during median 1,208 days (interquartile range: 598 to 2,177 days) of follow-up. Patients with previous aortic valve intervention were excluded.

    Results: Overall, 16,129 (6.7%), 3,315 (1.4%), and 6,383 (2.6%) patients had mild, moderate, and severe AS, respectively. On an adjusted basis (vs. no AS; 5-year mortality 19%), patients with mild to severe AS had an increasing risk of long-term mortality (adjusted hazard ratio: 1.44 to 2.09; p < 0.001 for all comparisons). The 5-year mortality was 56% and 67%, respectively, in those with moderate AS (mean gradient 20.0 to 39.0 mm Hg/peak velocity 3.0 to 3.9 m/s) and severe AS (≥40.0 mm Hg, ≥4.0 m/s, or AV area <1.0 cm2 in low-flow, low-gradient severe AS). A markedly increased risk of death from all causes (5-year mortality >50%) and cardiovascular disease was evident from a mean AV gradient >20.0 mm Hg (moderate AS) after adjusting for age, sex, left ventricular systolic or diastolic dysfunction, and aortic regurgitation.

    Conclusions: These data confirm that when left untreated, severe AS is associated with poor long-term survival. Moreover, they also suggest poor survival rates in patients with moderate AS. (National Echocardiographic Database of Australia [NEDA]; ACTRN12617001387314)

    Original languageEnglish
    Pages (from-to)1851-1863
    Number of pages13
    JournalJournal of the American College of Cardiology
    Volume74
    Issue number15
    DOIs
    Publication statusPublished - 15 Oct 2019

    Fingerprint

    Aortic Valve Stenosis
    Survival
    Aortic Valve
    Statistical Distributions
    Aortic Valve Insufficiency
    Mortality
    Cardiovascular Diseases
    Survival Rate
    Databases

    Cite this

    National Echocardiography Database of Australia contributing sites. / Poor Long-Term Survival in Patients With Moderate Aortic Stenosis. In: Journal of the American College of Cardiology. 2019 ; Vol. 74, No. 15. pp. 1851-1863.
    @article{c91ae43e74a54323a71b434cbaea58a7,
    title = "Poor Long-Term Survival in Patients With Moderate Aortic Stenosis",
    abstract = "Background: Historical data suggesting poor survival in patients with aortic stenosis (AS) who do not undergo treatment are largely confined to patients with severe AS. Objectives: This study sought to determine the prognostic impact of all levels of native valvular AS. Methods: Severity of AS was characterized by convention and by statistical distribution in 122,809 male patients (mean age 61 ± 17 years) and 118,494 female patients (mean age 62 ± 19 years), with measured aortic valve (AV) mean gradient, peak velocity, and/or area. The relationship between AS severity and survival was then examined during median 1,208 days (interquartile range: 598 to 2,177 days) of follow-up. Patients with previous aortic valve intervention were excluded. Results: Overall, 16,129 (6.7{\%}), 3,315 (1.4{\%}), and 6,383 (2.6{\%}) patients had mild, moderate, and severe AS, respectively. On an adjusted basis (vs. no AS; 5-year mortality 19{\%}), patients with mild to severe AS had an increasing risk of long-term mortality (adjusted hazard ratio: 1.44 to 2.09; p < 0.001 for all comparisons). The 5-year mortality was 56{\%} and 67{\%}, respectively, in those with moderate AS (mean gradient 20.0 to 39.0 mm Hg/peak velocity 3.0 to 3.9 m/s) and severe AS (≥40.0 mm Hg, ≥4.0 m/s, or AV area <1.0 cm2 in low-flow, low-gradient severe AS). A markedly increased risk of death from all causes (5-year mortality >50{\%}) and cardiovascular disease was evident from a mean AV gradient >20.0 mm Hg (moderate AS) after adjusting for age, sex, left ventricular systolic or diastolic dysfunction, and aortic regurgitation. Conclusions: These data confirm that when left untreated, severe AS is associated with poor long-term survival. Moreover, they also suggest poor survival rates in patients with moderate AS. (National Echocardiographic Database of Australia [NEDA]; ACTRN12617001387314)",
    keywords = "aortic stenosis, cohort, mortality",
    author = "{National Echocardiography Database of Australia contributing sites} and Geoff Strange and Simon Stewart and David Celermajer and David Prior and Scalia, {Gregory M.} and Thomas Marwick and Marcus Ilton and Majo Joseph and Jim Codde and David Playford",
    year = "2019",
    month = "10",
    day = "15",
    doi = "10.1016/j.jacc.2019.08.004",
    language = "English",
    volume = "74",
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    National Echocardiography Database of Australia contributing sites 2019, 'Poor Long-Term Survival in Patients With Moderate Aortic Stenosis', Journal of the American College of Cardiology, vol. 74, no. 15, pp. 1851-1863. https://doi.org/10.1016/j.jacc.2019.08.004

    Poor Long-Term Survival in Patients With Moderate Aortic Stenosis. / National Echocardiography Database of Australia contributing sites.

    In: Journal of the American College of Cardiology, Vol. 74, No. 15, 15.10.2019, p. 1851-1863.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Poor Long-Term Survival in Patients With Moderate Aortic Stenosis

    AU - National Echocardiography Database of Australia contributing sites

    AU - Strange, Geoff

    AU - Stewart, Simon

    AU - Celermajer, David

    AU - Prior, David

    AU - Scalia, Gregory M.

    AU - Marwick, Thomas

    AU - Ilton, Marcus

    AU - Joseph, Majo

    AU - Codde, Jim

    AU - Playford, David

    PY - 2019/10/15

    Y1 - 2019/10/15

    N2 - Background: Historical data suggesting poor survival in patients with aortic stenosis (AS) who do not undergo treatment are largely confined to patients with severe AS. Objectives: This study sought to determine the prognostic impact of all levels of native valvular AS. Methods: Severity of AS was characterized by convention and by statistical distribution in 122,809 male patients (mean age 61 ± 17 years) and 118,494 female patients (mean age 62 ± 19 years), with measured aortic valve (AV) mean gradient, peak velocity, and/or area. The relationship between AS severity and survival was then examined during median 1,208 days (interquartile range: 598 to 2,177 days) of follow-up. Patients with previous aortic valve intervention were excluded. Results: Overall, 16,129 (6.7%), 3,315 (1.4%), and 6,383 (2.6%) patients had mild, moderate, and severe AS, respectively. On an adjusted basis (vs. no AS; 5-year mortality 19%), patients with mild to severe AS had an increasing risk of long-term mortality (adjusted hazard ratio: 1.44 to 2.09; p < 0.001 for all comparisons). The 5-year mortality was 56% and 67%, respectively, in those with moderate AS (mean gradient 20.0 to 39.0 mm Hg/peak velocity 3.0 to 3.9 m/s) and severe AS (≥40.0 mm Hg, ≥4.0 m/s, or AV area <1.0 cm2 in low-flow, low-gradient severe AS). A markedly increased risk of death from all causes (5-year mortality >50%) and cardiovascular disease was evident from a mean AV gradient >20.0 mm Hg (moderate AS) after adjusting for age, sex, left ventricular systolic or diastolic dysfunction, and aortic regurgitation. Conclusions: These data confirm that when left untreated, severe AS is associated with poor long-term survival. Moreover, they also suggest poor survival rates in patients with moderate AS. (National Echocardiographic Database of Australia [NEDA]; ACTRN12617001387314)

    AB - Background: Historical data suggesting poor survival in patients with aortic stenosis (AS) who do not undergo treatment are largely confined to patients with severe AS. Objectives: This study sought to determine the prognostic impact of all levels of native valvular AS. Methods: Severity of AS was characterized by convention and by statistical distribution in 122,809 male patients (mean age 61 ± 17 years) and 118,494 female patients (mean age 62 ± 19 years), with measured aortic valve (AV) mean gradient, peak velocity, and/or area. The relationship between AS severity and survival was then examined during median 1,208 days (interquartile range: 598 to 2,177 days) of follow-up. Patients with previous aortic valve intervention were excluded. Results: Overall, 16,129 (6.7%), 3,315 (1.4%), and 6,383 (2.6%) patients had mild, moderate, and severe AS, respectively. On an adjusted basis (vs. no AS; 5-year mortality 19%), patients with mild to severe AS had an increasing risk of long-term mortality (adjusted hazard ratio: 1.44 to 2.09; p < 0.001 for all comparisons). The 5-year mortality was 56% and 67%, respectively, in those with moderate AS (mean gradient 20.0 to 39.0 mm Hg/peak velocity 3.0 to 3.9 m/s) and severe AS (≥40.0 mm Hg, ≥4.0 m/s, or AV area <1.0 cm2 in low-flow, low-gradient severe AS). A markedly increased risk of death from all causes (5-year mortality >50%) and cardiovascular disease was evident from a mean AV gradient >20.0 mm Hg (moderate AS) after adjusting for age, sex, left ventricular systolic or diastolic dysfunction, and aortic regurgitation. Conclusions: These data confirm that when left untreated, severe AS is associated with poor long-term survival. Moreover, they also suggest poor survival rates in patients with moderate AS. (National Echocardiographic Database of Australia [NEDA]; ACTRN12617001387314)

    KW - aortic stenosis

    KW - cohort

    KW - mortality

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    National Echocardiography Database of Australia contributing sites. Poor Long-Term Survival in Patients With Moderate Aortic Stenosis. Journal of the American College of Cardiology. 2019 Oct 15;74(15):1851-1863. https://doi.org/10.1016/j.jacc.2019.08.004