Author + information
- Received June 25, 2019
- Revision received July 25, 2019
- Accepted August 5, 2019
- Published online October 7, 2019.
- Geoff Strange, PhDa,∗ (, )
- Simon Stewart, PhDb,
- David Celermajer, MD, PhDc,
- David Prior, MBBS, PhDd,
- Gregory M. Scalia, MBBS (Hons), MMedSce,
- Thomas Marwick, MBBS, PhDf,
- Marcus Ilton, MDg,
- Majo Joseph, MBBSh,
- Jim Codde, PhDi,
- David Playford, MBBS, PhDa,
- on behalf of the National Echocardiography Database of Australia contributing sites
- aSchool of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
- bTorrens University Australia, Adelaide, South Australia, Australia
- cFaculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- dUniversity of Melbourne, St. Vincent’s Hospital, Melbourne, Victoria, Australia
- eUniversity of Queensland, The Prince Charles Hospital, Brisbane, Queensland, Australia
- fBaker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
- gMenzies School of Health Research, Royal Darwin Hospital, Darwin, Northern Territory, Australia
- hFlinders University, Adelaide, South Australia, Australia
- iUniversity of Notre Dame, Fremantle, Western Australia, Australia
- ↵∗Address for correspondence:
Dr. Geoff Strange, School of Medicine, University of Notre Dame, 32 Mouat Street, Fremantle, WA 6160 Australia.
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 cm2 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)
The National Echocardiography Database of Australia was originally established with funding support from Actelion, Bayer, and GlaxoSmithKline, and is supported by National Health and Medical Research Council of Australia grant 1055214. Dr. Strange has served on the Scientific Advisory Board for Edwards Lifesciences Australia. Dr. Prior has received speaker fees from Actelion and Novartis. Dr. Marwick has received research grant support for the SUCCOUR study from GE Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Deepak L. Bhatt, MD, MPH, served as Guest Editor-in-Chief for this paper.
- Received June 25, 2019.
- Revision received July 25, 2019.
- Accepted August 5, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.