Key result
AVR linked to ~63% lower mortality in asymptomatic severe AS with preserved LVEF and LVH.
Why the study?
Clinical guidelines reflect uncertainty regarding managing asymptomatic severe aortic stenosis and signs of subclinical ventricular injury, and prior data showed mortality reduction with AVR in severe AS with LVH but not in a confirmed asymptomatic cohort.
Does aortic valve replacement reduce mortality in asymptomatic individuals with severe aortic stenosis, preserved LVEF, and left ventricular hypertrophy?
Cohort (n=607)
Does aortic valve replacement reduce mortality in asymptomatic individuals with severe aortic stenosis, preserved LVEF, and left ventricular hypertrophy?
Effect estimate: HR 0.37 (95% CI 0.25-0.55)
Absolute Event Rate: 12.8% vs 58.5%
p-value: p=<0.001
In asymptomatic patients with severe aortic stenosis, preserved LVEF, and left ventricular hypertrophy, aortic valve replacement is associated with a significant reduction in mortality compared to conservative management.
May support AVR in asymptomatic severe AS with LVH; challenges guideline uncertainty but remains hypothesis-generating pending RCTs.
Background The development of left ventricular hypertrophy (LVH) could indicate ventricular injury and potential need for earlier aortic valve replacement (AVR) in asymptomatic severe aortic stenosis (AS). In clinical guidelines, there is uncertainty regarding the management of asymptomatic individuals and potential signs of subclinical ventricular injury. We have previously found mortality reduction in individuals with severe AS and LVH but not in a cohort confirmed asymptomatic. Methods From a previously established registry of 4856 individuals with normal flow, severe AS, LVEF ≥ 55% and LVH, we identified asymptomatic individuals from physician chart review. To assess the association between AVR and mortality, Cox proportional hazards models were used with the index echocardiogram as time zero. To address immortal time bias, AVR was considered a time-varying covariate. Results After application of eligibility criteria, 607 unique asymptomatic individuals were analyzed. Of those, 335 (55.2%) received AVR with 41.2% receiving surgical AVR and 58.8% receiving transcatheter AVR. Individuals who received AVR had lower unadjusted mortality than those who did not receive AVR (12.8% vs. 58.5%, p < 0.001). After adjustment and accounting for time-dependence of AVR, AVR was associated with reduced mortality (HR 0.37, 95% CI 0.25-0.55, p < 0.001). Conclusions AVR was associated with reduced mortality in a dedicated cohort of patients confirmed asymptomatic after physician chart review with severe asymptomatic AS, preserved LVEF, and LVH.
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WASFY et al. (2025) conducted a cohort in Asymptomatic severe aortic stenosis and left ventricular hypertrophy (n=607). Aortic valve replacement (AVR) vs. No AVR was evaluated on Mortality (HR 0.37, 95% CI 0.25-0.55, p=<0.001). Aortic valve replacement was associated with reduced mortality compared to no AVR in asymptomatic patients with severe aortic stenosis, preserved LVEF, and LVH (HR 0.37; 95% CI 0.25-0.55; p<0.001).
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