Heartbeat: markers of adverse outcomes in adults with severe aortic stenosis

Optimal management of adults with severe aortic stenosis (AS) remains controversial with several ongoing clinical trials evaluating the potential benefit of aortic valve replacement (AVR) earlier in the disease course when patients are still asymptomatic. To a large extent, these trials are based on evidence from the Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis (CURRENT AS) registry.1 A comprehensive review article by the CURRENT-AS investigators in this issue of Heart summarises the data from this large Japanese multi-centre retrospective registry of consecutive adults with severe AS (figure 1). Both clinicians caring for patients with AS and researchers engaged in (or thinking about) clinical trials will want to read this data summary and review. Figure 1 Potential reasons for the poor prognosis of asymptomatic patients with severe AS without aortic valve intervention. AVR is indicated in asymptomatic patients with depressed LV function (LVEF<50%) not due to other causes or very severe AS (Vmax≥5.0 m/s or mean aortic PG≥60 mm Hg) and in patients who develop symptoms during exercise testing. Asymptomatic patients with severe AS should be followed up under active clinical surveillance and should be referred for SAVR or TAVI if some symptoms emerge. However, assessment of symptoms is often difficult in clinical practice, especially in the elderly, leading to false diagnosis of ‘asymptomatic AS’. Furthermore, patients may …