Robert Lallemant, Damien Broucqsault, Karine Bauley, Jean-Pierre Coulomb, François Destombes, Olivier Hennebert, Jérôme Haye, David Montaigne, Xavier Dujardin, Octave Equine, Pascal de Groote, Bruno Fournier, Christophe Cordier, Hélène Ridon, Moulay Alaoui, Karim Chachoua, Messaoud Kouidri, Christophe Mycinski, Gérard Houdain, Aurélie Musschoot, Vincent Hennebelle, Rémy Lubret, Maïwenn Clement-Dupont, Philippe Lejeune, Julien Voyez, Frédéric Biausque, Sylvie Tondeux, Elise Dassonvalle, Antonio Gongora, Maxence Delomez, Michel Devillers, Nestor Lemaire, Augustin Coisne, Karima Ouchallal, Thibaud Meurice, Sébastien Caudmont, Bruno Vaquette, Nicolas Detis, Anne-Laure Madika, Laurence Avez-Lemaire, Dan Neicu, Charles Hudelo, Maud Wibaux, Dieudonné Tchatchoua, Thibault Hus, Laurent Carpentier, Nicolas Lamblin, Vladimir Cousin, Frédéric Mouquet, Marie Fertin, Thierry Jacquemart, Audrey Duchemin, Aida Ben Abda, Claire Vanesson, Max Pecheux, Belaid Jellouli, Mariam Arabidze, Rémy Viart, Mathilde Jacquelinet, Steve Werquin, Dauphine Garin, Yann Lefetz, Pascal Delsart, Mathieu Verhaeghe, Jean Becquart, Véronique Taverne, François Passard, Philippe Pruvost, Ahmed Amiar, Guillaume Ledieu, Hubert Vodoungnon, Anne-Sophie Polge, M. Richardson, Benoit Brullard, Arnaud Quercy, Eric Verbrugge, Christophe Bauters, Nima Endjah, Patrizio Lancellotti, Olivier Nugue, Karine Sautiere-Tricot, Gery Hannebicque, Alessandro Cosenza, Alain Petit, Valvenor Investigators, André Philias, Fanny Boudghene Stambouli, Luc Abramovici, François Leleu, Eric Decoulx, Guillaume de Geeter, Francis Kozlowski, Stéphanie Mouton, Anju Duva Pentiah, Rosario Pilato, Arthur Vaksmann, Kouroch Taghipour, Jean-Michel Bruffau, Benoit Segrestin, Alain Millaire, Dominique Vandamme, Akram Chmait, Lorraine Greffe, Patricia Langlois, Olivier Jabourek, Arnaud Hubert, Valérie Aumegeat, Christine Savoye, Rahma Ouardani, Antoine Jeu, Marc Sagot, Eléonore Hebbar, Philippe Marboeuf, Jean-Charles Aisenfarb, Bertrand Boutié, Samy Aghezzaf, Karine Pedelhez, Olivier Tricot, Jonathan Meurice, Hélène Bardet, and Olivia Domanski
Importance Modern data regarding incidence and modes of death of patients with aortic stenosis (AS) are restricted to tertiary centers or studies of aortic valve replacement (AVR). Objective To provide new insights into the natural history of outpatients with native AS based on a large regionwide population study with inclusion by all cardiologists regardless of their mode of practice. Design, Setting, and Participants Between May 2016 and December 2017, consecutive outpatients with mild (peak aortic velocity, 2.5-2.9 m/s), moderate (peak aortic velocity, 3-3.9 m/s), and severe (peak aortic velocity, ≥4 m/s) native AS graded by echocardiography were included by 117 cardiologists from the Nord-Pas-de-Calais region in France. Analysis took place between August and November 2020. Main Outcomes and Measures Natural history, need for AVR, and survival of patients with AS were followed up. Indications for AVR were based on current guideline recommendations. Results Among 2703 patients (mean [SD] age, 76.0 [10.8] years; 1260 [46.6%] women), 233 (8.6%) were recruited in a university public hospital, 757 (28%) in nonuniversity public hospitals, and 1713 (63.4%) by cardiologists working in private practice. A total of 1154 patients (42.7%) had mild, 1122 (41.5%) had moderate, and 427 (15.8%) had severe AS. During a median (interquartile range) of 2.1 (1.4-2.7) years, 634 patients underwent AVR and 448 died prior to AVR. Most deaths were cardiovascular (200 [44.7%]), mainly associated with congestive heart failure (101 [22.6%]) or sudden death (60 [13.4%]). Deaths were noncardiovascular in 186 patients (41.5%) and from unknown causes in 62 patients (13.8%). Compared with patients with mild AS, there was increased cardiovascular mortality in those with moderate (hazard ratio, 1.47 [95% CI, 1.07-2.02]) and severe (hazard ratio, 3.66 [95% CI, 2.52-5.31]) AS. The differences remained significant when adjusted for baseline characteristics or in time-dependent analyses considering AS progression. In asymptomatic patients, moderate and mild AS were associated with similar cardiovascular mortality (hazard ratio, 0.99 [95% CI, 0.44-2.21]). Conclusions and Relevance While patients in this study with moderate AS had a slightly higher risk of cardiovascular death than patients with mild AS, this risk was much lower than that observed in patients with severe AS. Moreover, in asymptomatic patients, moderate and mild AS were associated with similar cardiovascular mortality.