Moderate aortic stenosis (AS) is associated with high mortality rates, similar with rates observed in patients with severe AS, according to results of a Late-Breaking Science study presented Sept. 3 at ESC Congress 2019 and simultaneously published in the Journal of the American College of Cardiology.

Although studies have demonstrated that severe AS is associated with poor survival, the prognosis for patients with moderate AS has been unclear. This study used a large patient cohort from the National Echocardiographic Database of Australia observational registry to try to definitively determine the prognostic impact of increasing severity of AS. Severity of AS was characterized by conventional and statistical distribution in 122,809 men and 118,484 women, with measured aortic valve mean gradient, peak velocity or area. Participants were classified as having no evidence of AS (89 percent), mild AS (6.7 percent), moderate AS (1.4 percent) or severe AS (2.6 percent).

The relationship between AS severity and survival was assessed during a median 1,198 days of follow-up. A total of 44,235 (18 percent) participants died during follow-up. Adjusted results showed that participants with severe AS had a 1.9-fold increased risk of all-cause mortality during long-term follow-up. The adjusted five-year mortality was 19 percent among controls, 43 percent among participants with moderate AS and 53 percent among those with severe AS. The adjusted risk of five-year mortality among participants with moderate AS was increased 2.6-fold, approaching the 3.0-fold increased five-year mortality risk of those with severe AS.

Participants with mild AS had similar mortality risk to those without AS (adjusted hazard ratio [HR], 1.02). Mortality risk was similar among participants with moderate AS (adjusted HR, 1.19) and severe AS (adjusted HR, 1.22) vs. no AS.

"This represents the largest study of AS and long-term survival reported to date. We found high rates of mortality associated with both moderate and severe AS during long-term follow-up. As such, we confirm previous suggestions that moderate AS is not a benign condition. A re-evaluation of the prognostic impact of moderate AS and the potential value of more timely interventions to reduce a high-risk of mortality in the medium-to-longer term is warranted," concluded the authors.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Interventions and Imaging, Interventions and Structural Heart Disease, Angiography, Echocardiography/Ultrasound, Nuclear Imaging

Keywords: ESC 19, ESC Congress, Echocardiography, Aortic Valve Stenosis, Angiography, Percutaneous Coronary Intervention, Heart Valve Diseases

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