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Symptoms, disease severity and treatment of adults with a new diagnosis of severe aortic stenosis

Symptoms, disease severity and treatment of adults with a new diagnosis of severe aortic stenosis

Authors :
Frey, Norbert
Steeds, Richard Paul
Rudolph, Tanja K
Thambyrajah, Jeetendra
Serra, Antonio
Schulz, Eberhard
Maly, Jiri
Aiello, Marco
Lloyd, Guy
Bortone, Alessandro Santo
Hauptmann, Karl Eugen
Clerici, Alberto
Delle Karth, Georg
Rieber, Johannes
Indorfi, Ciro
Mancone, Massimo
Belle, Loic
Lauten, Alexander
Arnold, Martin
Bouma, Berto J
Lutz, Matthias
Pohlmann, Christiane
Kurucova, Jana
Thoenes, Martin
Bramlage, Peter
Messika-Zeitoun, David
Source :
Heart; 2019, Vol. 105 Issue: 22 p1709-1716, 8p
Publication Year :
2019

Abstract

ObjectiveContemporary data on patients with previously undiagnosed severe aortic stenosis (AS) are scarce. We aimed to address this gap by gathering data from consecutive patients diagnosed with severe AS on echocardiography.MethodsThis was a prospective, multicentre, multinational, registry in 23 tertiary care hospitals across 9 European countries. Patients with a diagnosis of severe AS were included using echocardiography (aortic valve area (AVA) <1 cm2, indexed AVA <0.6 cm2/m2, maximum jet-velocity (Vmax) >4 m/s and/or mean transvalvular gradient >40 mm Hg).ResultsThe 2171 participants had a mean age of 77.9 years and 48.0% were female. The mean AVA was 0.73 cm2, Vmax4.3 m/s and mean gradient 47.1 mm Hg; 62.1% had left ventricular hypertrophy and 27.3% an ejection fraction (EF) <50%. 1743 patients (80.3%) were symptomatic (shortness-of-breath 91.0%; dizziness 30.2%, chest pain 28.9%). Patients had a EuroSCORE II of 4.0; 25.3% had a creatinine clearance <50 mL/min, and 3.2% had an EF <30%. Symptomatic patients were older and had more comorbidities than asymptomatic patients. Despite European Society of Cardiology 2017 valvular heart disease guideline class I recommendation, in only 76.2% a decision was made for an intervention (transcatheter 50.4%, surgical aortic valve replacement 25.8%). In asymptomatic patients, 57.7% with a class I/IIa indication were scheduled for a procedure, while 36.3% patients without an indication had their valve replaced.ConclusionsThe majority of patients with severe AS presented at an advanced disease stage. Management of severe AS remained suboptimal in a significant proportion of contemporary patients with severe AS.Trial registration numberNCT02241447;Results.

Details

Language :
English
ISSN :
13556037 and 1468201X
Volume :
105
Issue :
22
Database :
Supplemental Index
Journal :
Heart
Publication Type :
Periodical
Accession number :
ejs51419400
Full Text :
https://doi.org/10.1136/heartjnl-2019-314940