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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 ≥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). Conclusions-Most patients with asymptomatic, hemodynamically significant AS will develop symptoms within 5 years. Sudden death occurs in≈1%/y. Age, chronic renal failure, inactivity, and aortic valve velocity are independently predictive of all-cause mortality.
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 ≥ 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 During follow-up, 352 (57%) of 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), inactivity (HR, 2.00; P = 0.001), and aortic valve velocity (HR, 1.46; P = 0.03) 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). Conclusions-Most patients with asymptomatic, Hemodynamically significant AS will develop symptoms within 5 years. Sudden death occurs in ≈1% / y. Age, chronic renal failure, inactivity, and aortic valve velocity are independently predictive of all-cause mortality.