The natural history of adults with asymptomatic, hemodynamically significant aortic stenosis
Key result
Doppler flow velocity ≥4.5 m/s in asymptomatic AS linked to ~390% higher cardiac event risk.
- RR 4.9
- P=0.004
- n=143
Authors
Discussion
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Implication
Cohort study reveals high symptom-free survival in asymptomatic aortic stenosis, indicating conservative management is safe until symptoms develop.
Key Points
- To document the natural history, clinical outcomes, and predictors of cardiac events in adults with asymptomatic, hemodynamically significant valvular aortic stenosis.
- Followed 143 asymptomatic adults with isolated valvular aortic stenosis defined by Doppler echocardiography peak systolic flow velocity ≥ 4 m/s.
- Compared outcomes between patients undergoing valve intervention within 3 months (Group 1, N=30) and those managed without early intervention (Group 2, N=113) over a mean follow-up of 20 months (range 6 to 48).
- In unoperated patients (Group 2), actuarial freedom from symptoms (angina, dyspnea, syncope) was 86% at 1 year and 62% at 2 years, while freedom from cardiac events was 93% at 1 year and 74% at 2 years.
- All 3 cardiac deaths in Group 2 were preceded by symptoms for at least 3 months, whereas Group 1 experienced 3 post-operative cardiac events (2 deaths, 1 reoperation).
- Doppler flow velocity (p = 0.004) and ejection fraction (p = 0.01) independently predicted cardiac events; peak velocity ≥ 4.5 m/s carried a relative risk of 4.9 (p = 0.004).
Study Design
Type
Cohort (n=143)
PICO
P
Population
143 adults with asymptomatic, isolated valvular aortic stenosis (peak systolic flow velocity ≥ 4 m/s) followed for a mean of 20 months.
E
Exposure / Comparator
Doppler flow velocity ≥ 4.5 m/s vs Doppler flow velocity < 4.5 m/s
O
Primary Outcome
Cardiac event — RR 4.9, p=0.004
Main Result
Relative Risk: 4.9
p-value: p=0.004
Cite This Study
Pellikka et al. (1990) conducted a cohort in asymptomatic, hemodynamically significant aortic stenosis (n=143). Doppler flow velocity ≥ 4.5 m/s vs. Doppler flow velocity < 4.5 m/s was evaluated on Cardiac event (RR 4.9, p=0.004). In adults with asymptomatic, hemodynamically significant aortic stenosis, a Doppler flow velocity ≥4.5 m/s was associated with an increased risk of sustaining a cardiac event (RR 4.9, p=0.004).