Un Underestimated Symptom of Aortic Stenosis

For the first time, this long term observational study on a large cohort of contemporary patients with aortic stenosis (AS), has shown syncope is an underestimated threat, associated with worse prognosis after surgical aortic valve replacement (SAVR).

It is interesting to note that other symptoms or early signs of AS that will normally indicate SAVR (dyspnea, angina or ventricular function deterioration) are associated with significantly better prognosis after SAVR. Patients presenting syncope usually display a specific pathophysiologic phenotype characterized by a smaller aortic valve area, smaller cardiac cavities, and lower stroke volumes.

The decision to replace the aortic valve is not always easy and requires thorough risk/Benefit ratio assessment.

Read also: Clinical Events after Deferral of LAD Treatment Guided by FFR or iFR.

Cardinal symptoms that indicate SAVR are angina, cardiac failure and syncope; however, it remains unclear whether these symptoms convey increased risk after SAVR or whether early detection, even when subtle, should be emphasized in the clinical practice.

A total 625 patients with isolated AS receiving elective SAVR were prospectively enrolled in this long-term study.

Patients presenting syncope had significantly smaller ventricular diameters (p=0.02), as well as smaller atrial diameters.

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They also had smaller valve areas (p=0.048) and lower stroke index volume.

After adjusting for variables, syncope was associated with over 100% increased mortality risk  (HR 2.27, p=0.04) at one year, and again, over 100% increased mortality risk (HR 2.11, p<0.001) at 10 years. On the contrary, dyspnea, angina or preoperatory ventricular failure were not associated with worse evolution after SAVR.

Original title: Syncope. The Underestimated Threat in Severe Aortic Stenosis.

Reference: Georg Goliasch et al. J Am Coll Cardiol Img 2019. Article in press.

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