Key result
Incident aortic stenosis was associated with increased all-cause mortality compared to no AS, ranging from a 1.42-fold higher risk in mild AS to 2.27-fold in severe high-gradient AS (all p<0.001).
Why the study?
There was a paucity of data describing the characteristics and consequences of incident aortic stenosis.
What is the incidence of aortic stenosis and its association with all-cause mortality in adults undergoing routine echocardiography?
Cohort (n=91,678)
What is the incidence of aortic stenosis and its association with all-cause mortality in adults undergoing routine echocardiography?
Relative Risk: 1.42
p-value: p=<0.001
Incident aortic stenosis of any grade is common among older patients undergoing routine echocardiography and is associated with a significantly increased risk of all-cause mortality.
Large-scale echo data now quantify incident AS incidence, progression, and mortality; leaves open optimal screening or intervention strategies.
OBJECTIVE: We addressed the paucity of data describing the characteristics and consequences of incident aortic stenosis (AS). METHODS: Adults undergoing echocardiography with a native aortic valve (AV) and no AS were studied. Subsequent age-specific and sex-specific incidence of AS were derived from echocardiograms conducted a median of 2.8 years apart. Progressive AV dysfunction and individually linked mortality were examined per AS category. RESULTS: 49 449 men (53.9%, 60.9±15.8 years) and 42 229 women (61.6±16.9 years) with no initial evidence of AS were identified. Subsequently, 6293 (6.9%) developed AS-comprising 5170 (5.6%), 636 (0.7%), 339 (0.4%) and 148 (0.2%) cases of mild, moderate, severe low-gradient and severe high-gradient AS, respectively. Age-adjusted incidence rates of all grades of AS were 17.5 cases per 1000 men/annum and 18.7 cases per 1000 women/annum: rising from ~5 to ~40 cases per 1000/annum in those aged <30 years vs >80 years. Median peak AV velocity increased by +0.57 (+0.36 to +0.80) m/s in mild AS compared with +2.75 (+2.40 to +3.19) m/s in severe high-gradient AS cases between first and last echocardiograms. During subsequent median 7.7 years follow-up, 24 577 of 91 678 cases (26.8%) died. Compared with no AS, the adjusted risk of all-cause mortality was 1.42-fold higher in mild AS, 1.92-fold higher in moderate AS, 1.95-fold higher in severe low-gradient AS and 2.27-fold higher in severe, high-gradient AS cases (all p<0.001). CONCLUSIONS: New onset AS is a common finding among older patients followed up with echocardiography. Any grade of AS is associated with higher mortality, reinforcing the need for proactive vigilance.
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Stewart et al. (2021) conducted a cohort in Incident aortic stenosis (n=91,678). Incident aortic stenosis vs. No aortic stenosis was evaluated on All-cause mortality (RR 1.42, p=<0.001). Incident aortic stenosis was associated with increased all-cause mortality compared to no AS, ranging from a 1.42-fold higher risk in mild AS to 2.27-fold in severe high-gradient AS (all p<0.001).
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