Poor Long-Term Survival in Patients With Moderate Aortic Stenosis
Open accessAbstract
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 cm 2 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).
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Moderate AS is not benign and is associated with a prognosis almost as bad as severe AS.
“Furthermore, there is a strong growing body of evidence suggesting that moderate AS is not benign and is associated with a dismal prognosis almost as bad as severe AS. 5”
From Grading of Aortic Valve Calcification Severity and Risk Stratification in Aortic Stenosis (2024) · cites this paper as [5]
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- Authors
- Strange, G., Stewart, S., Celermajer, D., Prior, D., Scalia, G. M., Marwick, T., Ilton, M., Joseph, M., Codde, J., & Playford, D.
- Affiliations
- The University of Notre Dame Australia (AU)
- Torrens University Australia (AU)
- The University of Sydney (AU)
- The University of Melbourne (AU)
- The University of Queensland (AU)
- Baker Heart and Diabetes Institute (AU)
- Menzies School of Health Research (AU)
- Flinders University (AU)
- Corresponding author
- Strange, Geoff
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2019-10
- Volume
- 74
- Issue
- 15
- Pages
- 1851-1863
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2972012128
- Cited by
- 412
- References
- 27
- Citations by year
- 2026: 40 · 2025: 50 · 2024: 72 · 2023: 83 · 2022: 75 · 2021: 52 · 2020: 36 · 2019: 4
- FWCI
- 30.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Funders
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
- Keywords
- aortic stenosis, moderate aortic stenosis, long-term survival, mortality, low-flow low-gradient aortic stenosis, cardiovascular mortality, left ventricular systolic dysfunction, left ventricular diastolic dysfunction, aortic regurgitation
- MeSH terms
- Aged, Aged, 80 and over, Aortic Valve, Aortic Valve Insufficiency, Aortic Valve Stenosis, Australia, Echocardiography, Female, Heart Ventricles, Humans, Male, Middle Aged, New Zealand, Prognosis, Prospective Studies, Registries, Retrospective Studies, Severity of Illness Index, Stroke Volume, Databases, Factual, Treatment Outcome, Ventricular Dysfunction, Left, Heart Valve Prosthesis Implantation
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