Key result
Asymptomatic severe aortic stenosis was an independent predictor of all-cause mortality in adults aged 80 and older (adjusted HR 3.16; 95% CI 1.97-4.88; p<.001).
Why the study?
Does asymptomatic severe aortic stenosis increase the risk of all-cause mortality in adults aged 80 and older with preserved LVEF?
Cohort (n=1,060)
No
Does asymptomatic severe aortic stenosis increase the risk of all-cause mortality in adults aged 80 and older with preserved LVEF?
Hazard Ratio: 3.16 (95% CI 1.97–4.88)
p-value: p=<.001
Asymptomatic severe aortic stenosis is associated with a significantly increased risk of all-cause mortality in adults aged 80 and older, suggesting a major prognostic impact even in the very elderly.
Asymptomatic severe AS signals high mortality risk in adults ≥80; leaves open whether early intervention improves outcomes in this population.
OBJECTIVES: To examine the effect of asymptomatic severe aortic stenosis (AS) on mortality late in life. DESIGN: Retrospective cohort study. SETTING: Large medical center. PARTICIPANTS: Asymptomatic adults aged 80 and older (mean age 86 ± 4; N=1,060, n=569 women) with preserved left ventricular ejection fraction (LVEF; > 50%); 927 (87.5%) with no AS, 70 (6.6%) with nonsevere AS, and 63 (5.9%) with severe AS. MEASUREMENTS: Information was collected on demographic characteristics, comorbidities, and laboratory and echocardiographic data. Survival was assessed according to longest follow-up available. RESULTS: During a mean follow-up of 2.2 ± 2.3 years, there were 203 (19%) deaths, 51 of which were from cardiovascular causes. Four-year estimates of survival were 72% for no AS, 58% for nonsevere AS, and 23% for severe AS (p<.001). Univariable analysis showed that asymptomatic severe AS was significantly associated with greater risk of all-cause mortality (hazard ratio (HR)=3.06, 95% confidence interval (CI)=1.96-4.58, p<.001). After adjustment for age, sex, LVEF, hypertension, dyslipidemia, diabetes, atrial fibrillation, chronic kidney disease, and coronary artery disease, asymptomatic severe AS was an independent predictor of all-cause mortality (HR=3.16, 95% CI=1.97-4.88, p<.001). CONCLUSION: Asymptomatic severe AS has a major effect on prognosis even in very old adults.
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Suzuki et al. (2018) conducted a cohort in asymptomatic severe aortic stenosis (n=1,060). Asymptomatic severe aortic stenosis vs. No aortic stenosis was evaluated on all-cause mortality (HR 3.16, 95% CI 1.97-4.88, p=<.001). Asymptomatic severe aortic stenosis was an independent predictor of all-cause mortality in adults aged 80 and older (adjusted HR 3.16; 95% CI 1.97-4.88; p<.001).
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