The natural history of adults with asymptomatic, hemodynamically significant aortic stenosis

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.

The natural history of asymptomatic, hemodynamically significant, valvular aortic stenosis in adults was documented. Of 471 patients with aortic stenosis identified by Doppler echocardiography (peak systolic flow velocity greater than or equal to 4 m/s) from January 1984 through August 1987, 143 were asymptomatic and had isolated valvular aortic stenosis. Thirty patients underwent aortic valve intervention within 3 months (group 1); the remaining 113 patients did not have an intervention within 3 months (group 2). Follow-up information was available for all patients; the mean duration of follow-up study was 20 months (range 6 to 48). Three cardiac events occurred in the 30 group 1 patients after operation (two deaths, one reoperation). Among the 113 group 2 patients, three had cardiac death presumed to be a result of the aortic stenosis; all three developed symptoms at least 3 months before death. The actuarial probability of remaining free of symptoms of angina, dyspnea or syncope for group 2 was 86% at 1 year and 62% at 2 years. For this group, the 1 and 2 year probabilities of remaining free of cardiac events, including aortic valve intervention or cardiac death, were 93% and 74%, respectively. Of all clinical and echocardiographic variables (group 2), only Doppler flow velocity (p = 0.004) and ejection fraction (p = 0.01) were independent predictors of subsequent cardiac events. Among the 44 patients (groups 1 and 2) with a flow velocity greater than or equal to 4.5 m/s, the relative risk of sustaining a cardiac event (by Cox regression analysis) was 4.9 (p = 0.004).(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				P. Sorajja, R. A. Nishimura, B. J. Gersh, J. A. Dearani, D. O. Hodge, H. J. Wiste, and S. R. Ommen Outcome of mildly symptomatic or asymptomatic obstructive hypertrophic cardiomyopathy: a long-term follow-up study. J. Am. Coll. Cardiol., July 14, 2009; 54(3): 234 - 241. [Abstract] [Full Text] [PDF]

				I. M. SINGH, E. M. TUZCU, M. H. SHISHEHBOR, S. R. KAPADIA, and R. D. CHRISTOFFERSON Percutaneous treatment of aortic valve stenosis Cleveland Clinic Journal of Medicine, November 1, 2008; 75(11): 805 - 812. [Abstract] [Full Text] [PDF]

				J. P. Dal-Bianco, B. K. Khandheria, F. Mookadam, F. Gentile, and P. P. Sengupta Management of Asymptomatic Severe Aortic Stenosis J. Am. Coll. Cardiol., October 14, 2008; 52(16): 1279 - 1292. [Abstract] [Full Text] [PDF]

				2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons Circulation, October 7, 2008; 118(15): e523 - e661. [Full Text] [PDF]

				R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J. Am. Coll. Cardiol., September 23, 2008; 52(13): e1 - e142. [Full Text] [PDF]

				S. H. Rahimtoola Valvular heart disease: a perspective on the asymptomatic patient with severe valvular aortic stenosis Eur. Heart J., July 2, 2008; 29(14): 1783 - 1790. [Abstract] [Full Text] [PDF]

				P. Lancellotti, D. Karsera, G. Tumminello, F. Lebois, and L. A. Pierard Determinants of an abnormal response to exercise in patients with asymptomatic valvular aortic stenosis Eur J Echocardiogr, May 1, 2008; 9(3): 338 - 343. [Abstract] [Full Text] [PDF]

				J. Minners, M. Allgeier, C. Gohlke-Baerwolf, R.-P. Kienzle, F.-J. Neumann, and N. Jander Inconsistencies of echocardiographic criteria for the grading of aortic valve stenosis Eur. Heart J., April 2, 2008; 29(8): 1043 - 1048. [Abstract] [Full Text] [PDF]

				T. Mihaljevic, M. R. Sayeed, S. C. Stamou, and S. Paul Pathophysiology of Aortic Valve Disease Card. Surg. Adult, January 1, 2008; 3(2008): 825 - 840. [Full Text]

				N. D. Desai and G. T. Christakis Bioprosthetic Aortic Valve Replacement: Stented Pericardial and Porcine Valves Card. Surg. Adult, January 1, 2008; 3(2008): 857 - 894. [Full Text]

				R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): e1 - e148. [Full Text] [PDF]

				R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): 598 - 675. [Full Text] [PDF]

				H. Baumgartner Aortic stenosis: medical and surgical management Heart, November 1, 2005; 91(11): 1483 - 1488. [Full Text] [PDF]

				M. Kupari, H. Turto, and J. Lommi Left ventricular hypertrophy in aortic valve stenosis: preventive or promotive of systolic dysfunction and heart failure? Eur. Heart J., September 1, 2005; 26(17): 1790 - 1796. [Abstract] [Full Text] [PDF]

				P. Lancellotti, F. Lebois, M. Simon, C. Tombeux, C. Chauvel, and L. A. Pierard Prognostic Importance of Quantitative Exercise Doppler Echocardiography in Asymptomatic Valvular Aortic Stenosis Circulation, August 30, 2005; 112(9_suppl): I-377 - I-382. [Abstract] [Full Text] [PDF]

				P. Das, H. Rimington, and J. Chambers Exercise testing to stratify risk in aortic stenosis Eur. Heart J., July 1, 2005; 26(13): 1309 - 1313. [Abstract] [Full Text] [PDF]

				H. Baumgartner Management of asymptomatic aortic stenosis: how helpful is exercise testing? Eur. Heart J., July 1, 2005; 26(13): 1252 - 1254. [Full Text] [PDF]

				R. V. Freeman and C. M. Otto Spectrum of Calcific Aortic Valve Disease: Pathogenesis, Disease Progression, and Treatment Strategies Circulation, June 21, 2005; 111(24): 3316 - 3326. [Full Text] [PDF]

				P. A. Pellikka, M. E. Sarano, R. A. Nishimura, J. F. Malouf, K. R. Bailey, C. G. Scott, M. E. Barnes, and A. J. Tajik Outcome of 622 Adults With Asymptomatic, Hemodynamically Significant Aortic Stenosis During Prolonged Follow-Up Circulation, June 21, 2005; 111(24): 3290 - 3295. [Abstract] [Full Text] [PDF]

				J. Bergler-Klein, U. Klaar, M. Heger, R. Rosenhek, G. Mundigler, H. Gabriel, T. Binder, R. Pacher, G. Maurer, and H. Baumgartner Natriuretic Peptides Predict Symptom-Free Survival and Postoperative Outcome in Severe Aortic Stenosis Circulation, May 18, 2004; 109(19): 2302 - 2308. [Abstract] [Full Text] [PDF]

				R. Rosenhek, U. Klaar, M. Schemper, C. Scholten, M. Heger, H. Gabriel, T. Binder, G. Maurer, and H. Baumgartner Mild and moderate aortic stenosis: Natural history and risk stratification by echocardiography Eur. Heart J., February 1, 2004; 25(3): 199 - 205. [Abstract] [Full Text] [PDF]

				I. L. Gerber, R. A.H. Stewart, M. E. Legget, T. M. West, R. L. French, T. M. Sutton, T. G. Yandle, J. K. French, A. M. Richards, and H. D. White Increased Plasma Natriuretic Peptide Levels Reflect Symptom Onset in Aortic Stenosis Circulation, April 15, 2003; 107(14): 1884 - 1890. [Abstract] [Full Text] [PDF]

				J. Bermejo, R. Odreman, J. Feijoo, M. M. Moreno, P. Gomez-Moreno, and M. A. Garcia-Fernandez Clinical efficacy of Doppler-echocardiographic indices of aortic valve stenosis:a comparative test-based analysis of outcome J. Am. Coll. Cardiol., January 1, 2003; 41(1): 142 - 151. [Abstract] [Full Text] [PDF]

				N. D. Desai and G. T. Christakis Stented Mechanical/Bioprosthetic Aortic Valve Replacement Card. Surg. Adult, January 1, 2003; 2(2003): 825 - 856. [Full Text]

				R. Rosenhek, G. Maurer, and H. Baumgartner Should early elective surgery be performed in patients with severe but asymptomatic aortic stenosis? Eur. Heart J., September 2, 2002; 23(18): 1417 - 1421. [Full Text] [PDF]

				B. Iung, C. Gohlke-Barwolf, P. Tornos, C. Tribouilloy, R. Hall, E. Butchart, and A. Vahanian Recommendations on the management of the asymptomatic patient with valvular heart disease Eur. Heart J., August 2, 2002; 23(16): 1253 - 1266. [PDF]

				B. A. Carabello Evaluation and Management of Patients With Aortic Stenosis Circulation, April 16, 2002; 105(15): 1746 - 1750. [Full Text] [PDF]

				B. A. Carabello Aortic Stenosis N. Engl. J. Med., February 28, 2002; 346(9): 677 - 682. [Full Text] [PDF]

				J. CHAMBERS and P. DAS Treadmill exercise in apparently asymptomatic aortic stenosis Heart, October 1, 2001; 86(4): 361 - 362. [Full Text] [PDF]

				M C M Amato, P J Moffa, K E Werner, and J A F Ramires Treatment decision in asymptomatic aortic valve stenosis: role of exercise testing Heart, October 1, 2001; 86(4): 381 - 386. [Abstract] [Full Text] [PDF]

				S.G. Priori, E. Aliot, C. Blomstrom-Lundqvist, L. Bossaert, G. Breithardt, P. Brugada, A.J. Camm, R. Cappato, S.M. Cobbe, C. Di Mario, et al. Task Force on Sudden Cardiac Death of the European Society of Cardiology Eur. Heart J., August 2, 2001; 22(16): 1374 - 1450. [PDF]

				S Takeda, H Rimington, N Smeeton, and J Chambers Long axis excursion in aortic stenosis Heart, July 1, 2001; 86(1): 52 - 56. [Abstract] [Full Text] [PDF]

				B J Bouma, J H P van der Meulen, R B A van den Brink, A E R Arnold, A Smidts, L H Teunter, K I Lie, and J G P Tijssen Variability in treatment advice for elderly patients with aortic stenosis: a nationwide survey in the Netherlands Heart, February 1, 2001; 85(2): 196 - 201. [Abstract] [Full Text]

				G. W. Petty, B. K. Khandheria, J. P. Whisnant, J. D. Sicks, W. M. O'Fallon, and D. O. Wiebers Predictors of Cerebrovascular Events and Death Among Patients With Valvular Heart Disease : A Population-Based Study Stroke, November 1, 2000; 31(11): 2628 - 2635. [Abstract] [Full Text] [PDF]

				P. Das, C. Pocock, and J. Chambers The patient with a systolic murmur: severe aortic stenosis may be missed during cardiovascular examination QJM, October 1, 2000; 93(10): 685 - 688. [Abstract] [Full Text] [PDF]

				R. Rosenhek, T. Binder, G. Porenta, I. Lang, G. Christ, M. Schemper, G. Maurer, and H. Baumgartner Predictors of Outcome in Severe, Asymptomatic Aortic Stenosis N. Engl. J. Med., August 31, 2000; 343(9): 611 - 617. [Abstract] [Full Text] [PDF]

				P Kvidal, R Bergstrom, T Malm, and E Stahle Long-term follow-up of morbidity and mortality after aortic valve replacement with a mechanical valve prosthesis Eur. Heart J., July 1, 2000; 21(13): 1099 - 1111. [Abstract] [PDF]

				S. Palta, A. M. Pai, K. S. Gill, and R. G. Pai New Insights Into the Progression of Aortic Stenosis : Implications for Secondary Prevention Circulation, May 30, 2000; 101(21): 2497 - 2502. [Abstract] [Full Text] [PDF]

				B J Bouma, R B A van den Brink, J H P van der Meulen, H A Verheul, E C Cheriex, H P M Hamer, E Dekker, K I Lie, and J G P Tijssen To operate or not on elderly patients with aortic stenosis: the decision and its consequences Heart, August 1, 1999; 82(2): 143 - 148. [Abstract] [Full Text] [PDF]

				B. A. Carabello and F. A. Crawford Valvular Heart Disease N. Engl. J. Med., July 3, 1997; 337(1): 32 - 41. [Full Text] [PDF]

				B. A. Carabello Timing of Valve Replacement in Aortic Stenosis : Moving Closer to Perfection Circulation, May 6, 1997; 95(9): 2241 - 2243. [Full Text]

				C. M. Otto, I. G. Burwash, M. E. Legget, B. I. Munt, M. Fujioka, N. L. Healy, C. D. Kraft, C. Y. Miyake-Hull, and R. G. Schwaegler Prospective Study of Asymptomatic Valvular Aortic Stenosis : Clinical, Echocardiographic, and Exercise Predictors of Outcome Circulation, May 6, 1997; 95(9): 2262 - 2270. [Abstract] [Full Text]

				B. K. Julius, M. Spillmann, G. Vassalli, B. Villari, F. R. Eberli, and O. M. Hess Angina Pectoris in Patients With Aortic Stenosis and Normal Coronary Arteries: Mechanisms and Pathophysiological Concepts Circulation, February 18, 1997; 95(4): 892 - 898. [Abstract] [Full Text]

				T. Stefenelli, C. Abela, H. Frank, J. Koller-Strametz, S. Globits, J. Bergler-Klein, and B. Niederle Cardiac Abnormalities in Patients with Primary Hyperparathyroidism: Implications for Follow-Up J. Clin. Endocrinol. Metab., January 1, 1997; 82(1): 106 - 112. [Abstract] [Full Text] [PDF]

				J. A. Odell, C. J. Mullany, H. V. Schaff, T. A. Orszulak, R. C. Daly, and J. J. Morris Aortic Valve Replacement After Previous Coronary Artery Bypass Grafting Ann. Thorac. Surg., November 1, 1996; 62(5): 1424 - 1430. [Abstract] [Full Text]

				A. Gehlot, C. J. Mullany, D. Ilstrup, H. V. Schaff, T. A. Orszulak, J. J. Morris, and R. C. Daly AORTIC VALVE REPLACEMENT IN PATIENTS AGED EIGHTY YEARS AND OLDER: EARLY AND LONG-TERM RESULTS J. Thorac. Cardiovasc. Surg., May 1, 1996; 111(5): 1026 - 1036. [Abstract] [Full Text]

				B. R. Celli and E. J. Mark Case 11-1993- A 52-Year-Old Man with Cardiomyopathy and Pulmonary Disease N. Engl. J. Med., March 18, 1993; 328(11): 792 - 800. [Full Text]

				AORTIC STENOSIS IS BENIGN -- AS LONG AS IT IS ASYMPTOMATIC Journal Watch (General), April 17, 1990; 1990(417): 2 - 2. [Full Text]