Clinical course of patients diagnosed with severe aortic stenosis in the Rotterdam area: insights from the AVARIJN study

Abstract

To prospectively evaluate the clinical course of patients with severe aortic stenosis (AS) and identify factors associated with treatment selection and patient outcome. Patients diagnosed with severe AS in the Rotterdam area were included between June 2006 and May 2009. Patient characteristics, echocardiogram, brain natriuretic peptide (NT-proBNP), and treatment strategy were assessed at baseline, and after 6, 12, and 24months. Endpoints were aortic valve replacement (AVR) / transcatheter aortic valve implantation (TAVI) and death. The study population comprised 191 patients, 132 were symptomatic and 59 asymptomatic at study entry. Two-year cumulative survival of symptomatic patients was 89.8% (95% CI 79.8-95.0%) after AVR/TAVI and 72.6% (95% CI 59.7-82.0%) with conservative treatment. Two-year cumulative survival of asymptomatic patients was 91.5% (95% CI 80.8-96.4%). Two-year cumulative incidence of AVR/TAVI was 55.9% (95% CI 47.5-63.5%) in symptomatic patients. Sixty-eight percent of asymptomatic patients developed symptoms, median time to symptoms was 13months; AVR/TAVI cumulative incidence was 38.3% (95% CI 23.1-53.3%). Elderly symptomatic patients with multiple comorbidities were more likely to receive conservative treatment. In contemporary Dutch practice many symptomatic patients do not receive invasive treatment of severe AS. Two-thirds of asymptomatic patients develop symptoms within 2years, illustrating the progressive nature of severe AS. Treatment optimisation may be achieved through careful individualised assessment in a multidisciplinary setting.