Aortic stenosis (AS) is a progressive disease associated with morbidity and mortality, especially in severe cases. However, recent studies have revealed that moderate stenosis can also have unfavorable consequences in the course of the disease.
One of the challenges lies in that determining its severity is sometimes difficult due to discrepancies between valve area, gradient, and peak velocity, which can lead to confusion regarding the presence of symptoms.
In a study that included 595,120 patients, 70,778 (11.9%) were identified as having some degree of AS. Of them, 48.9% had mild stenosis (L), 8.2% mild to moderate (L/M), 20.6% moderate (M), 5.2% moderate to severe (M/S), and 17.1% severe (S) stenosis.
As AS became more severe, there was an increase in age and risk factors such as hypertension, diabetes, atrial fibrillation, coronary artery disease, heart attack, percutaneous coronary intervention, myocardial revascularization surgery, chronic obstructive pulmonary disease, cancer, ejection fraction lower than 50%, smaller aortic valve area, lower gradient, and higher presence of atrioventricular valve regurgitation.
Read also: Low Gradient, Normal Flow Aortic Stenosis: Changes in Quality of Life with TAVR.
After four years of follow-up, mortality among those who did not receive treatment was 13.5% (95% CI: 13.3%-13.7%) for those without AS, and for those with mild, mild to moderate, moderate, moderate to severe, and severe AS it was 25.0%, 29.7%, 33.5%, 45.7%, and 44.9%, respectively. In those who received treatment, the mortality rate was 0.2%, 1.0%, 4.2%, 11.4%, 36.7%, and 60.7%, respectively.
In an adjusted multivariate analysis, untreated aortic stenosis, regardless of the degree, was associated with an increase in mortality.
Conclusion
In conclusion, patients with aortic stenosis face a significant risk of mortality at all severity levels without treatment. Nevertheless, aortic valve replacement remains low in cases of severe aortic stenosis, indicating the need for further research to understand diagnostic barriers and define the appropriate timing for aortic valve replacement.
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: The Mortality Burden of Untreated Aortic Stenosis.
Reference: Philippe Généreux, et al. J Am Coll Cardiol 2023;82:2101–2109.
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