Author + information
- Received December 15, 2015
- Revision received May 12, 2016
- Accepted May 19, 2016
- Published online January 2, 2017.
- Robert Zilberszac, MDa,
- Harald Gabriel, MDa,
- Michael Schemper, PhDb,
- Günther Laufer, MDc,
- Gerald Maurer, MDa and
- Raphael Rosenhek, MDa,∗ ()
- aDepartment of Cardiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
- bDepartment of Medical Statistics and Informatics, Section of Clinical Biometrics, University of Vienna, Vienna, Austria
- cDepartment of Cardiac Surgery, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
- ↵∗Reprint requests and correspondence:
Dr. Raphael Rosenhek, Department of Cardiology, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
Objectives This study sought to assess the natural history and optimal timing of surgery in elderly patients with severe asymptomatic aortic stenosis (AS).
Background AS is increasingly diagnosed in an aging population, and large numbers of elderly patients are undergoing aortic valve procedures. However, the average age of patients represented in most natural history studies on AS is between 60 and 70 years.
Methods A total of 103 consecutive patients >70 years of age (51 female; mean age 77 ± 5 years) with asymptomatic severe AS (peak aortic jet velocity [AV-Vel] 4.7 ± 0.6 m/s) were prospectively followed.
Results During follow-up, 91 events occurred, including an indication for aortic valve replacement in 82 patients and cardiac deaths in 9, respectively. Event-free survival was 73%, 43%, 23%, and 16% at 1, 2, 3, and 4 years, respectively. Physical mobility was impaired in 29% of the patients, and symptom onset was severe (New York Heart Association functional class ≥III) in 43% of those who developed symptoms. Patients with AV-Vel ≥5.0 m/s had event-free survival rates of 21% and 6% at 2 and 4 years, respectively, compared with 57% and 23% for patients with AV-Vel <5.0 m/s (p < 0.001). Seventy-one patients underwent aortic valve replacement, and post-operative survival was 89% and 77% after 1 and 3 years, respectively.
Conclusions In elderly patients with severe but asymptomatic AS, mild symptoms may be difficult to detect, particularly when mobility is impaired and severe symptom onset is common, warranting close clinical follow-up. Furthermore, a very high event rate can be expected, and cardiac deaths are not infrequent. Thus, elective aortic valve procedures may be considered in selected elderly patients at low procedural risk.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 15, 2015.
- Revision received May 12, 2016.
- Accepted May 19, 2016.
- American College of Cardiology Foundation