Data from recent observational randomized studies suggest that most patients with asymptomatic severe aortic stenosis will eventually receive an indication for valve replacement.
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.
Reference: Brigitta Gahl et al. JAMA Cardiol. 2020;5(10):1102-1112. doi:10.1001/jamacardio.2020.2497.
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