PMID- 31491546
OWN - NLM
STAT- MEDLINE
DCOM- 20200601
LR  - 20200601
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 74
IP  - 15
DP  - 2019 Oct 15
TI  - Poor Long-Term Survival in Patients With Moderate Aortic Stenosis.
PG  - 1851-1863
LID - S0735-1097(19)36192-3 [pii]
LID - 10.1016/j.jacc.2019.08.004 [doi]
AB  - BACKGROUND: Historical data suggesting poor survival in patients with aortic 
      stenosis (AS) who do not undergo treatment are largely confined to patients with 
      severe AS. OBJECTIVES: This study sought to determine the prognostic impact of 
      all levels of native valvular AS. METHODS: Severity of AS was characterized by 
      convention and by statistical distribution in 122,809 male patients (mean age 61 
      +/- 17 years) and 118,494 female patients (mean age 62 +/- 19 years), with measured 
      aortic valve (AV) mean gradient, peak velocity, and/or area. The relationship 
      between AS severity and survival was then examined during median 1,208 days 
      (interquartile range: 598 to 2,177 days) of follow-up. Patients with previous 
      aortic valve intervention were excluded. RESULTS: Overall, 16,129 (6.7%), 3,315 
      (1.4%), and 6,383 (2.6%) patients had mild, moderate, and severe AS, 
      respectively. On an adjusted basis (vs. no AS; 5-year mortality 19%), patients 
      with mild to severe AS had an increasing risk of long-term mortality (adjusted 
      hazard ratio: 1.44 to 2.09; p < 0.001 for all comparisons). The 5-year mortality 
      was 56% and 67%, respectively, in those with moderate AS (mean gradient 20.0 to 
      39.0 mm Hg/peak velocity 3.0 to 3.9 m/s) and severe AS (>/=40.0 mm Hg, >/=4.0 m/s, or 
      AV area <1.0 cm(2) in low-flow, low-gradient severe AS). A markedly increased 
      risk of death from all causes (5-year mortality >50%) and cardiovascular disease 
      was evident from a mean AV gradient >20.0 mm Hg (moderate AS) after adjusting for 
      age, sex, left ventricular systolic or diastolic dysfunction, and aortic 
      regurgitation. CONCLUSIONS: These data confirm that when left untreated, severe 
      AS is associated with poor long-term survival. Moreover, they also suggest poor 
      survival rates in patients with moderate AS. (National Echocardiographic Database 
      of Australia [NEDA]; ACTRN12617001387314).
CI  - Copyright (c) 2019 American College of Cardiology Foundation. All rights reserved.
FAU - Strange, Geoff
AU  - Strange G
AD  - School of Medicine, University of Notre Dame, Fremantle, Western Australia, 
      Australia. Electronic address: gstrange@neda.net.au.
FAU - Stewart, Simon
AU  - Stewart S
AD  - Torrens University Australia, Adelaide, South Australia, Australia.
FAU - Celermajer, David
AU  - Celermajer D
AD  - Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, 
      Australia.
FAU - Prior, David
AU  - Prior D
AD  - University of Melbourne, St. Vincent's Hospital, Melbourne, Victoria, Australia.
FAU - Scalia, Gregory M
AU  - Scalia GM
AD  - University of Queensland, The Prince Charles Hospital, Brisbane, Queensland, 
      Australia.
FAU - Marwick, Thomas
AU  - Marwick T
AD  - Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
FAU - Ilton, Marcus
AU  - Ilton M
AD  - Menzies School of Health Research, Royal Darwin Hospital, Darwin, Northern 
      Territory, Australia.
FAU - Joseph, Majo
AU  - Joseph M
AD  - Flinders University, Adelaide, South Australia, Australia.
FAU - Codde, Jim
AU  - Codde J
AD  - University of Notre Dame, Fremantle, Western Australia, Australia.
FAU - Playford, David
AU  - Playford D
AD  - School of Medicine, University of Notre Dame, Fremantle, Western Australia, 
      Australia.
CN  - National Echocardiography Database of Australia contributing sites
LA  - eng
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20190903
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
SB  - IM
CIN - J Am Coll Cardiol. 2019 Oct 15;74(15):1864-1867. PMID: 31601366
CIN - J Am Coll Cardiol. 2020 Feb 25;75(7):837. PMID: 32081290
CIN - J Am Coll Cardiol. 2020 Feb 25;75(7):838-839. PMID: 32081291
CIN - J Thorac Dis. 2020 Nov;12(11):7064-7068. PMID: 33282412
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve
MH  - Aortic Valve Insufficiency/complications/epidemiology/mortality
MH  - Aortic Valve Stenosis/complications/*epidemiology/*mortality
MH  - Australia/epidemiology
MH  - Databases, Factual
MH  - Echocardiography
MH  - Female
MH  - Heart Valve Prosthesis Implantation/adverse effects
MH  - Heart Ventricles/pathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - New Zealand/epidemiology
MH  - Prognosis
MH  - Prospective Studies
MH  - Registries
MH  - Retrospective Studies
MH  - Severity of Illness Index
MH  - Stroke Volume
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left
OTO - NOTNLM
OT  - aortic stenosis
OT  - cohort
OT  - mortality
EDAT- 2019/09/07 06:00
MHDA- 2020/06/02 06:00
CRDT- 2019/09/07 06:00
PHST- 2019/06/25 00:00 [received]
PHST- 2019/07/25 00:00 [revised]
PHST- 2019/08/05 00:00 [accepted]
PHST- 2019/09/07 06:00 [pubmed]
PHST- 2020/06/02 06:00 [medline]
PHST- 2019/09/07 06:00 [entrez]
AID - S0735-1097(19)36192-3 [pii]
AID - 10.1016/j.jacc.2019.08.004 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2019 Oct 15;74(15):1851-1863. doi: 10.1016/j.jacc.2019.08.004. 
      Epub 2019 Sep 3.