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Objectives The aim of the study was to examine the predictive value of QRS duration and morphology during watchful waiting in asymptomatic patients with aortic stenosis (AS). Background QRS duration and morphology are associated with poor prognosis in many different populations, but the predictive value, particularly of the risk of sudden cardiac death (SCD), in asymptomatic patients with AS has not been well studied. Methods Data were obtained in asymptomatic AS patients randomized to simvastatin/ezetimibe combination versus placebo in the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study. The impact of QRS duration, evaluated as a categorical variable of = 100 ms (excluding bundle branch block [BBB]) and QRS morphology in those with BBB, on cardiovascular morbidity and mortality was assessed by adjusting for clinical and echocardiographic covariates. Results QRS data were available in 1,542 patients who were followed for a mean of 4.3 +/- 0.8 years (6,631 patient-years of follow-up). There were 68 cardiovascular deaths (4.6%), including 27 SCDs (1.8%). QRS duration was = 100 ms in those without BBB in 144 (9.3%), and 102 (6.6%) in those with BBB. In multivariable analyses, those with QRS duration >= 100 ms had, compared with those with QRS duration

Valvular heart disease, particularly aortic stenosis and mitral regurgitation, accounts for a large proportion of cardiology practice, and their prevalence is predicted to increase. Management of the asymptomatic patient remains controversial. Biomarkers have been shown to have utility in the management of cardiovascular disease such as heart failure and acute coronary syndromes. In this state-of-the-art review, we examine the current evidence relating to natriuretic peptides as potential biomarkers in aortic stenosis and mitral regurgitation. The natriuretic peptides correlate with measures of disease severity and symptomatic status and also can be used to predict outcome. This review shows that natriuretic peptides have much promise as biomarkers in common valvular heart disease, but the impact of their measurement on clinical practice and outcomes needs to be further assessed in prospective studies before routine clinical use becomes a reality.

Asymptomatic aortic stenosis (AS) carries risk of heart failure and sudden death during watchful waiting. However, it remains unclear whether NT-proBNP, and its change from last year, in asymptomatic aortic valve stenosis (AS) predicts outcome. We evaluated 1577 asymptomatic AS patients from the

ECG signs of myocardial abnormality provide independent prognostic information in asymptomatic aortic stenosis (AS). It is unknown if the sum of ECG abnormalities further improves discriminatory power for prediction of cardiovascular outcomes. Patients with complete 12-lead ECGs in the simvastatin/

We hypothesized that increased myocardial oxygen consumption (MOC) may be a predictor of heart failure (HF) in mild-to-moderate aortic stenosis (AS). MOC was available in 1,623 (87%) of 1,873 patients in the Simvastatin in Ezetimibe in Aortic Stenosis study with asymptomatic mild-to-moderate AS.

The aim of the study was to examine the predictive value of QRS duration and morphology during watchful waiting in asymptomatic patients with aortic stenosis (AS).QRS duration and morphology are associated with poor prognosis in many different populations, but the predictive value, particularly of the risk of sudden cardiac death (SCD), in asymptomatic patients with AS has not been well studied.Data were obtained in asymptomatic AS patients randomized to simvastatin/ezetimibe combination versus placebo in the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study. The impact of QRS duration, evaluated as a categorical variable of85 ms versus 85 to 99 ms and ≥100 ms (excluding bundle branch block [BBB]) and QRS morphology in those with BBB, on cardiovascular morbidity and mortality was assessed by adjusting for clinical and echocardiographic covariates.QRS data were available in 1,542 patients who were followed for a mean of 4.3 ± 0.8 years (6,631 patient-years of follow-up). There were 68 cardiovascular deaths (4.6%), including 27 SCDs (1.8%). QRS duration was85 ms in 900 patients (58.4%), 85 to 99 ms in 396 (25.7%), ≥100 ms in those without BBB in 144 (9.3%), and 102 (6.6%) in those with BBB. In multivariable analyses, those with QRS duration ≥100 ms had, compared with those with QRS duration85 ms, a 5-fold higher risk of SCD (95% confidence interval: 1.8 to 13.7, p = 0.002) and a 2.5-fold higher risk of cardiovascular death (95% confidence interval: 1.2 to 5.1, p = 0.01).QRS duration and morphology in asymptomatic patients with AS are independently associated with a poor prognosis, particularly the risk of SCD.

Beta-blockers (BB) are frequently avoided in aortic stenosis (AS) patients because of fear of depression of left ventricular function. We evaluated if BB increased the risk of cardiovascular events in patients with mild to moderate AS. Post-hoc analysis from the Simvastatin and Ezetimibe in Aortic

Observational data indicate a possible effect of statin therapy on reducing risk of lens opacities. 1,873 patients with asymptomatic aortic stenosis and no history of diabetes, coronary heart disease or other serious comorbidities were randomized (1:1) to double-blind 40 mg simvastatin plus 10 mg

Transcatheter aortic valve implantation (TAVI) is considered in patients with severe aortic stenosis who are not suitable or high risk for open surgery. Access via the femoral approach is not feasible in people with extensive iliac and femoral vascular disease and in these patients alternative