Asymptomatic Severe Aortic Stenosis, When Should We Intervene?

Data from recent observational randomized studies suggest that most patients with asymptomatic severe aortic stenosis will eventually receive an indication for valve replacement.

Infarto agudo de miocardio y lesiones de múltiples niveles

 

Mortality in this “asymptomatic” population is caused not only by sudden death, but also by cardiac death. Early intervention may prevent these deaths as a consequence of aortic stenosis symptoms.

Researchers conducted a meta-analysis to learn about the natural contemporary history of asymptomatic severe aortic stenosis. Their main concern was all-cause death occurring during conservative treatment.

Cardiac death, death due to heart failure, sudden death, symptom onset, indication for aortic valve replacement, and aortic valve replacement were also assessed.

The primary endpoint of this study was comparing long-term mortality among patients receiving early intervention vs. those receiving conservative treatment (intervention only after symptom onset).


Read also: Intervention in Congenital Heart Disease.


A total of 4075 patients from 29 studies were analyzed.

Early intervention was associated with a significant reduction in long-term mortality (hazard ratio: 0.38; 95% confidence interval, 0.25-0.58).

Factors associated with worse prognosis in asymptomatic patients were severity of stenosis, low-flow, ventricular damage, and concomitant atherosclerotic disease.

Conclusion

Data from observational randomized studies suggest that the onset of symptoms in aortic stenosis may be cardiac death (such as heart failure), and not only sudden death. Other endpoints besides sudden death should be considered during the decision to perform early valve intervention.

jamacardiology_gahl_2020_oi_200043_1602688141-17564free

Original Title: Natural History of Asymptomatic Severe Aortic Stenosis and the Association of Early Intervention With Outcomes A Systematic Review and Meta-analysis.

Reference: Brigitta Gahl et al. JAMA Cardiol. 2020;5(10):1102-1112. doi:10.1001/jamacardio.2020.2497.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

More articles by this author

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...

TAVR in Young Low-Risk Patients

Transcatheter aortic valve replacement (TAVR) has established itself as an effective strategy for the treatment of severe aortic stenosis across different risk groups. While previous...

TAVR and Atrial Fibrillation: What Anticoagulants Should We Use?

The prevalence of atrial fibrillation (AF) in TAVR patients ranges from 15 to 30%, depending on series. This arrhythmia has been associated to higher...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...