Outcomes of Patients with Asymptomatic Aortic Stenosis Followed Up in Heart Valve Clinics

Patrizio Lancellotti, Julien Magne, Raluca Dulgheru, Marie Annick Clavel, Erwan Donal, Mani A. Vannan, John Chambers, Raphael Rosenhek, Gilbert Habib, Guy Lloyd, Stefano Nistri, Madalina Garbi, Stella Marchetta, Khalil Fattouch, Augustin Coisne, David Montaigne, Thomas Modine, Laurent Davin, Olivier Gach, Marc Radermecker & 17 others Shizhen Liu, Linda Gillam, Andrea Rossi, Elena Galli, Federica Ilardi, Lionel Tastet, Romain Capoulade, Robert Zilberszac, E. Mara Vollema, Victoria Delgado, Bernard Cosyns, Stephane Lafitte, Anne Bernard, Luc A. Pierard, Jeroen J. Bax, Philippe Pibarot, Cécile Oury

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Importance: The natural history and the management of patients with asymptomatic aortic stenosis (AS) have not been fully examined in the current era. Objective: To determine the clinical outcomes of patients with asymptomatic AS using data from the Heart Valve Clinic International Database. Design, Setting, and Participants: This registry was assembled by merging data from prospectively gathered institutional databases from 10 heart valve clinics in Europe, Canada, and the United States. Asymptomatic patients with an aortic valve area of 1.5 cm2 or less and preserved left ventricular ejection fraction (LVEF) greater than 50% at entry were considered for the present analysis. Data were collected from January 2001 to December 2014, and data were analyzed from January 2017 to July 2018. Main Outcomes and Measures: Natural history, need for aortic valve replacement (AVR), and survival of asymptomatic patients with moderate or severe AS at entry followed up in a heart valve clinic. Indications for AVR were based on current guideline recommendations. Results: Of the 1375 patients included in this analysis, 834 (60.7%) were male, and the mean (SD) age was 71 (13) years. A total of 861 patients (62.6%) had severe AS (aortic valve area less than 1.0 cm2). The mean (SD) overall survival during medical management (mean [SD] follow up, 27 [24] months) was 93% (1%), 86% (2%), and 75% (4%) at 2, 4, and 8 years, respectively. A total of 104 patients (7.6%) died under observation, including 57 patients (54.8%) from cardiovascular causes. The crude rate of sudden death was 0.65% over the duration of the study. A total of 542 patients (39.4%) underwent AVR, including 388 patients (71.6%) with severe AS at study entry and 154 (28.4%) with moderate AS at entry who progressed to severe AS. Those with severe AS at entry who underwent AVR did so at a mean (SD) of 14.4 (16.6) months and a median of 8.7 months. The mean (SD) 2-year and 4-year AVR-free survival rates for asymptomatic patients with severe AS at baseline were 54% (2%) and 32% (3%), respectively. In those undergoing AVR, the 30-day postprocedural mortality was 0.9%. In patients with severe AS at entry, peak aortic jet velocity (greater than 5 m/s) and LVEF (less than 60%) were associated with all-cause and cardiovascular mortality without AVR; these factors were also associated with postprocedural mortality in those patients with severe AS at baseline who underwent AVR (surgical AVR in 310 patients; transcatheter AVR in 78 patients). Conclusions and Relevance: In patients with asymptomatic AS followed up in heart valve centers, the risk of sudden death is low, and rates of overall survival are similar to those reported from previous series. Patients with severe AS at baseline and peak aortic jet velocity of 5.0 m/s or greater or LVEF less than 60% have increased risks of all-cause and cardiovascular mortality even after AVR. The potential benefit of early intervention should be considered in these high-risk patients.

Original languageEnglish (US)
Pages (from-to)1060-1068
Number of pages9
JournalJAMA Cardiology
Volume3
Issue number11
DOIs
StatePublished - Nov 1 2018

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Heart Valves
Aortic Valve Stenosis
Aortic Valve
Stroke Volume
Mortality
Sudden Death
Natural History
Survival Rate
Databases
Survival

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Lancellotti, P., Magne, J., Dulgheru, R., Clavel, M. A., Donal, E., Vannan, M. A., ... Oury, C. (2018). Outcomes of Patients with Asymptomatic Aortic Stenosis Followed Up in Heart Valve Clinics. JAMA Cardiology, 3(11), 1060-1068. https://doi.org/10.1001/jamacardio.2018.3152
Lancellotti, Patrizio ; Magne, Julien ; Dulgheru, Raluca ; Clavel, Marie Annick ; Donal, Erwan ; Vannan, Mani A. ; Chambers, John ; Rosenhek, Raphael ; Habib, Gilbert ; Lloyd, Guy ; Nistri, Stefano ; Garbi, Madalina ; Marchetta, Stella ; Fattouch, Khalil ; Coisne, Augustin ; Montaigne, David ; Modine, Thomas ; Davin, Laurent ; Gach, Olivier ; Radermecker, Marc ; Liu, Shizhen ; Gillam, Linda ; Rossi, Andrea ; Galli, Elena ; Ilardi, Federica ; Tastet, Lionel ; Capoulade, Romain ; Zilberszac, Robert ; Vollema, E. Mara ; Delgado, Victoria ; Cosyns, Bernard ; Lafitte, Stephane ; Bernard, Anne ; Pierard, Luc A. ; Bax, Jeroen J. ; Pibarot, Philippe ; Oury, Cécile. / Outcomes of Patients with Asymptomatic Aortic Stenosis Followed Up in Heart Valve Clinics. In: JAMA Cardiology. 2018 ; Vol. 3, No. 11. pp. 1060-1068.
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abstract = "Importance: The natural history and the management of patients with asymptomatic aortic stenosis (AS) have not been fully examined in the current era. Objective: To determine the clinical outcomes of patients with asymptomatic AS using data from the Heart Valve Clinic International Database. Design, Setting, and Participants: This registry was assembled by merging data from prospectively gathered institutional databases from 10 heart valve clinics in Europe, Canada, and the United States. Asymptomatic patients with an aortic valve area of 1.5 cm2 or less and preserved left ventricular ejection fraction (LVEF) greater than 50{\%} at entry were considered for the present analysis. Data were collected from January 2001 to December 2014, and data were analyzed from January 2017 to July 2018. Main Outcomes and Measures: Natural history, need for aortic valve replacement (AVR), and survival of asymptomatic patients with moderate or severe AS at entry followed up in a heart valve clinic. Indications for AVR were based on current guideline recommendations. Results: Of the 1375 patients included in this analysis, 834 (60.7{\%}) were male, and the mean (SD) age was 71 (13) years. A total of 861 patients (62.6{\%}) had severe AS (aortic valve area less than 1.0 cm2). The mean (SD) overall survival during medical management (mean [SD] follow up, 27 [24] months) was 93{\%} (1{\%}), 86{\%} (2{\%}), and 75{\%} (4{\%}) at 2, 4, and 8 years, respectively. A total of 104 patients (7.6{\%}) died under observation, including 57 patients (54.8{\%}) from cardiovascular causes. The crude rate of sudden death was 0.65{\%} over the duration of the study. A total of 542 patients (39.4{\%}) underwent AVR, including 388 patients (71.6{\%}) with severe AS at study entry and 154 (28.4{\%}) with moderate AS at entry who progressed to severe AS. Those with severe AS at entry who underwent AVR did so at a mean (SD) of 14.4 (16.6) months and a median of 8.7 months. The mean (SD) 2-year and 4-year AVR-free survival rates for asymptomatic patients with severe AS at baseline were 54{\%} (2{\%}) and 32{\%} (3{\%}), respectively. In those undergoing AVR, the 30-day postprocedural mortality was 0.9{\%}. In patients with severe AS at entry, peak aortic jet velocity (greater than 5 m/s) and LVEF (less than 60{\%}) were associated with all-cause and cardiovascular mortality without AVR; these factors were also associated with postprocedural mortality in those patients with severe AS at baseline who underwent AVR (surgical AVR in 310 patients; transcatheter AVR in 78 patients). Conclusions and Relevance: In patients with asymptomatic AS followed up in heart valve centers, the risk of sudden death is low, and rates of overall survival are similar to those reported from previous series. Patients with severe AS at baseline and peak aortic jet velocity of 5.0 m/s or greater or LVEF less than 60{\%} have increased risks of all-cause and cardiovascular mortality even after AVR. The potential benefit of early intervention should be considered in these high-risk patients.",
author = "Patrizio Lancellotti and Julien Magne and Raluca Dulgheru and Clavel, {Marie Annick} and Erwan Donal and Vannan, {Mani A.} and John Chambers and Raphael Rosenhek and Gilbert Habib and Guy Lloyd and Stefano Nistri and Madalina Garbi and Stella Marchetta and Khalil Fattouch and Augustin Coisne and David Montaigne and Thomas Modine and Laurent Davin and Olivier Gach and Marc Radermecker and Shizhen Liu and Linda Gillam and Andrea Rossi and Elena Galli and Federica Ilardi and Lionel Tastet and Romain Capoulade and Robert Zilberszac and Vollema, {E. Mara} and Victoria Delgado and Bernard Cosyns and Stephane Lafitte and Anne Bernard and Pierard, {Luc A.} and Bax, {Jeroen J.} and Philippe Pibarot and C{\'e}cile Oury",
year = "2018",
month = "11",
day = "1",
doi = "10.1001/jamacardio.2018.3152",
language = "English (US)",
volume = "3",
pages = "1060--1068",
journal = "JAMA Cardiology",
issn = "2380-6583",
publisher = "American Medical Association",
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Lancellotti, P, Magne, J, Dulgheru, R, Clavel, MA, Donal, E, Vannan, MA, Chambers, J, Rosenhek, R, Habib, G, Lloyd, G, Nistri, S, Garbi, M, Marchetta, S, Fattouch, K, Coisne, A, Montaigne, D, Modine, T, Davin, L, Gach, O, Radermecker, M, Liu, S, Gillam, L, Rossi, A, Galli, E, Ilardi, F, Tastet, L, Capoulade, R, Zilberszac, R, Vollema, EM, Delgado, V, Cosyns, B, Lafitte, S, Bernard, A, Pierard, LA, Bax, JJ, Pibarot, P & Oury, C 2018, 'Outcomes of Patients with Asymptomatic Aortic Stenosis Followed Up in Heart Valve Clinics', JAMA Cardiology, vol. 3, no. 11, pp. 1060-1068. https://doi.org/10.1001/jamacardio.2018.3152

Outcomes of Patients with Asymptomatic Aortic Stenosis Followed Up in Heart Valve Clinics. / Lancellotti, Patrizio; Magne, Julien; Dulgheru, Raluca; Clavel, Marie Annick; Donal, Erwan; Vannan, Mani A.; Chambers, John; Rosenhek, Raphael; Habib, Gilbert; Lloyd, Guy; Nistri, Stefano; Garbi, Madalina; Marchetta, Stella; Fattouch, Khalil; Coisne, Augustin; Montaigne, David; Modine, Thomas; Davin, Laurent; Gach, Olivier; Radermecker, Marc; Liu, Shizhen; Gillam, Linda; Rossi, Andrea; Galli, Elena; Ilardi, Federica; Tastet, Lionel; Capoulade, Romain; Zilberszac, Robert; Vollema, E. Mara; Delgado, Victoria; Cosyns, Bernard; Lafitte, Stephane; Bernard, Anne; Pierard, Luc A.; Bax, Jeroen J.; Pibarot, Philippe; Oury, Cécile.

In: JAMA Cardiology, Vol. 3, No. 11, 01.11.2018, p. 1060-1068.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcomes of Patients with Asymptomatic Aortic Stenosis Followed Up in Heart Valve Clinics

AU - Lancellotti, Patrizio

AU - Magne, Julien

AU - Dulgheru, Raluca

AU - Clavel, Marie Annick

AU - Donal, Erwan

AU - Vannan, Mani A.

AU - Chambers, John

AU - Rosenhek, Raphael

AU - Habib, Gilbert

AU - Lloyd, Guy

AU - Nistri, Stefano

AU - Garbi, Madalina

AU - Marchetta, Stella

AU - Fattouch, Khalil

AU - Coisne, Augustin

AU - Montaigne, David

AU - Modine, Thomas

AU - Davin, Laurent

AU - Gach, Olivier

AU - Radermecker, Marc

AU - Liu, Shizhen

AU - Gillam, Linda

AU - Rossi, Andrea

AU - Galli, Elena

AU - Ilardi, Federica

AU - Tastet, Lionel

AU - Capoulade, Romain

AU - Zilberszac, Robert

AU - Vollema, E. Mara

AU - Delgado, Victoria

AU - Cosyns, Bernard

AU - Lafitte, Stephane

AU - Bernard, Anne

AU - Pierard, Luc A.

AU - Bax, Jeroen J.

AU - Pibarot, Philippe

AU - Oury, Cécile

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Importance: The natural history and the management of patients with asymptomatic aortic stenosis (AS) have not been fully examined in the current era. Objective: To determine the clinical outcomes of patients with asymptomatic AS using data from the Heart Valve Clinic International Database. Design, Setting, and Participants: This registry was assembled by merging data from prospectively gathered institutional databases from 10 heart valve clinics in Europe, Canada, and the United States. Asymptomatic patients with an aortic valve area of 1.5 cm2 or less and preserved left ventricular ejection fraction (LVEF) greater than 50% at entry were considered for the present analysis. Data were collected from January 2001 to December 2014, and data were analyzed from January 2017 to July 2018. Main Outcomes and Measures: Natural history, need for aortic valve replacement (AVR), and survival of asymptomatic patients with moderate or severe AS at entry followed up in a heart valve clinic. Indications for AVR were based on current guideline recommendations. Results: Of the 1375 patients included in this analysis, 834 (60.7%) were male, and the mean (SD) age was 71 (13) years. A total of 861 patients (62.6%) had severe AS (aortic valve area less than 1.0 cm2). The mean (SD) overall survival during medical management (mean [SD] follow up, 27 [24] months) was 93% (1%), 86% (2%), and 75% (4%) at 2, 4, and 8 years, respectively. A total of 104 patients (7.6%) died under observation, including 57 patients (54.8%) from cardiovascular causes. The crude rate of sudden death was 0.65% over the duration of the study. A total of 542 patients (39.4%) underwent AVR, including 388 patients (71.6%) with severe AS at study entry and 154 (28.4%) with moderate AS at entry who progressed to severe AS. Those with severe AS at entry who underwent AVR did so at a mean (SD) of 14.4 (16.6) months and a median of 8.7 months. The mean (SD) 2-year and 4-year AVR-free survival rates for asymptomatic patients with severe AS at baseline were 54% (2%) and 32% (3%), respectively. In those undergoing AVR, the 30-day postprocedural mortality was 0.9%. In patients with severe AS at entry, peak aortic jet velocity (greater than 5 m/s) and LVEF (less than 60%) were associated with all-cause and cardiovascular mortality without AVR; these factors were also associated with postprocedural mortality in those patients with severe AS at baseline who underwent AVR (surgical AVR in 310 patients; transcatheter AVR in 78 patients). Conclusions and Relevance: In patients with asymptomatic AS followed up in heart valve centers, the risk of sudden death is low, and rates of overall survival are similar to those reported from previous series. Patients with severe AS at baseline and peak aortic jet velocity of 5.0 m/s or greater or LVEF less than 60% have increased risks of all-cause and cardiovascular mortality even after AVR. The potential benefit of early intervention should be considered in these high-risk patients.

AB - Importance: The natural history and the management of patients with asymptomatic aortic stenosis (AS) have not been fully examined in the current era. Objective: To determine the clinical outcomes of patients with asymptomatic AS using data from the Heart Valve Clinic International Database. Design, Setting, and Participants: This registry was assembled by merging data from prospectively gathered institutional databases from 10 heart valve clinics in Europe, Canada, and the United States. Asymptomatic patients with an aortic valve area of 1.5 cm2 or less and preserved left ventricular ejection fraction (LVEF) greater than 50% at entry were considered for the present analysis. Data were collected from January 2001 to December 2014, and data were analyzed from January 2017 to July 2018. Main Outcomes and Measures: Natural history, need for aortic valve replacement (AVR), and survival of asymptomatic patients with moderate or severe AS at entry followed up in a heart valve clinic. Indications for AVR were based on current guideline recommendations. Results: Of the 1375 patients included in this analysis, 834 (60.7%) were male, and the mean (SD) age was 71 (13) years. A total of 861 patients (62.6%) had severe AS (aortic valve area less than 1.0 cm2). The mean (SD) overall survival during medical management (mean [SD] follow up, 27 [24] months) was 93% (1%), 86% (2%), and 75% (4%) at 2, 4, and 8 years, respectively. A total of 104 patients (7.6%) died under observation, including 57 patients (54.8%) from cardiovascular causes. The crude rate of sudden death was 0.65% over the duration of the study. A total of 542 patients (39.4%) underwent AVR, including 388 patients (71.6%) with severe AS at study entry and 154 (28.4%) with moderate AS at entry who progressed to severe AS. Those with severe AS at entry who underwent AVR did so at a mean (SD) of 14.4 (16.6) months and a median of 8.7 months. The mean (SD) 2-year and 4-year AVR-free survival rates for asymptomatic patients with severe AS at baseline were 54% (2%) and 32% (3%), respectively. In those undergoing AVR, the 30-day postprocedural mortality was 0.9%. In patients with severe AS at entry, peak aortic jet velocity (greater than 5 m/s) and LVEF (less than 60%) were associated with all-cause and cardiovascular mortality without AVR; these factors were also associated with postprocedural mortality in those patients with severe AS at baseline who underwent AVR (surgical AVR in 310 patients; transcatheter AVR in 78 patients). Conclusions and Relevance: In patients with asymptomatic AS followed up in heart valve centers, the risk of sudden death is low, and rates of overall survival are similar to those reported from previous series. Patients with severe AS at baseline and peak aortic jet velocity of 5.0 m/s or greater or LVEF less than 60% have increased risks of all-cause and cardiovascular mortality even after AVR. The potential benefit of early intervention should be considered in these high-risk patients.

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Lancellotti P, Magne J, Dulgheru R, Clavel MA, Donal E, Vannan MA et al. Outcomes of Patients with Asymptomatic Aortic Stenosis Followed Up in Heart Valve Clinics. JAMA Cardiology. 2018 Nov 1;3(11):1060-1068. https://doi.org/10.1001/jamacardio.2018.3152