What is the clinical evidence from this study?

Study design: Cohort. Population: Possible severe aortic stenosis (n=3220). Intervention: Aortic valve replacement (AVR). Primary outcome: One-year mortality (HR 0.46, 95% CI 0.37-0.57).

What does this research mean for the field?

Patients with possible severe aortic stenosis, particularly those with low-gradient severe AS, are a high-risk population that experiences substantial underutilization and variation in confirmatory testing and aortic valve replacement based on patient and provider characteristics. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This analysis aims to assess recognition and treatment patterns in patients with possible severe aortic stenosis and their associated outcomes.

June 1, 2026Open Access

Evaluation, Treatment, and Outcomes in Patients With Possible Severe Aortic Stenosis

Key Result

Aortic valve replacement was associated with lower one-year mortality (HR 0.46; 95% CI 0.37-0.57) in patients with possible severe aortic stenosis.

Key Points

This analysis aims to assess recognition and treatment patterns in patients with possible severe aortic stenosis and their associated outcomes.
Retrospective analysis of echocardiogram data from the Duke Echocardiography Laboratory Database (2016-2024).
Patients with possible severe AS were identified based on specific echocardiographic parameters.
Outcomes included confirmatory testing rates, aortic valve replacement rates, heart failure hospitalization, and all-cause mortality.
3,220 individuals had possible severe AS, with only 18.1% undergoing confirmatory testing in the low-gradient severe AS group.
Out of 1,452 patients who underwent AVR, 1-year mortality was significantly lower (HR 0.46; 95% CI 0.37 – 0.57).
The overall mortality rate was 17.6 per 100 person-years, higher in those with advanced cardiac stages.

Study Design

Type

Cohort (n=3,220)

Multicenter

Structured PICO

Does aortic valve replacement improve survival in patients with possible severe aortic stenosis?

Population

3,220 individuals with possible severe AS (AVA <1.0 cm2, mean aortic valve gradient ≥40mmHg, peak aortic velocity ≥4.0 m/s) and possible low-gradient severe AS (AVA <1.0cm2, aortic gradient <40mmHg and peak velocity of <4m/s)

Intervention

Aortic valve replacement (AVR)

Outcome

Percent of patients receiving appropriate confirmatory testing, aortic valve replacement (AVR), heart failure (HF) hospitalization (total events) and all-cause mortalityhard clinical

In patients with possible severe AS, confirmatory testing is underutilized, but AVR is associated with significantly lower one-year mortality.

Main Result

Effect estimate: HR 0.46 (95% CI 0.37-0.57)

Abstract

Background Severe aortic stenosis (AS) is associated with significant morbidity and mortality. Prior reports suggest that severe AS is under-recognized and undertreated. Methods Retrospective analysis of the Duke Echocardiography Laboratory Database of individuals undergoing an echocardiogram between 2016 and 2024. Patients with possible severe AS (any of the following: aortic valve area (AVA) <1.0 cm 2 , mean aortic valve gradient ≥40mmHg, peak aortic velocity ≥4.0 m/s) and possible low-gradient severe AS (AVA <1.0cm 2 , aortic gradient <40mmHg and peak velocity of <4m/s) were identified. Individuals were stratified based on stage of cardiac damage. Outcomes of interest included percent of patients receiving appropriate confirmatory testing, aortic valve replacement (AVR), heart failure (HF) hospitalization (total events) and all-cause mortality. Results Of 114,171 unique individuals who underwent echocardiography, 3,220 had possible severe AS. Those with possible low-gradient severe AS (n = 1,764) infrequently underwent confirmatory testing (18.1% at 1-year). Over a median of 1.4 years of follow-up 1,452 (45.1%) underwent AVR. Significant predictors of AVR utilization included age <75, sex, advanced stage of cardiac damage, absence of symptoms, frailty, ordering provider and severity reported in the echocardiogram. AVR was associated with lower one-year mortality (hazard ratio 0.46; 95% CI 0.37 – 0.57). Overall, the population demonstrated a mortality rate of 17.6 per 100 person-years and a HF hospitalization rate of 13.5 per 100 person-years, which were higher in those with advanced cardiac stages and those with possible low-gradient severe AS. Conclusion Patients with possible severe AS represent a high-risk population with substantial variation in confirmatory testing and AVR utilization, including differences across patient characteristics and provider factors.