Prognosis of asymptomatic elderly patients with aortic stenosis

Abstract

To elucidate the prognosis of elderly patients with asymptomatic aortic stenosis (AS) and to assess the timing of aortic valve replacement (AVR), 21 asymptomatic patients (8 men, 13 women, mean age: 75 +/- 8 years (54-89 years)), who had Doppler echocardiographic evidence of a significant aortic pressure gradient of greater than 40 mmHg (mean gradient: 75 +/- 31 mmHg), were followed for 33 +/- 10 months. During the follow-up, there were 4 cardiac events (2 cardiac deaths, 2 late AVRs), and 2 non-cardiac deaths (cerebro-vascular accidents). Among 15 survivors, 13 patients were in NYHA class I--II, and the remaining 2 patients were found to have malignant disease. Compared to the 17 patients without cardiac events, those with cardiac events had significantly larger CTR (58 +/- 6% vs. 53 +/- 3%; p less than 0.01), although there were no significant difference in electrocardiographic LVH, echocardiographic LV mass, and Doppler pressure gradient between the two groups. The prevalence of the development of cardiac symptoms during the follow-up was not high (12%) in patients without cardiac events. Among 4 patients with cardiac events, one patient who was 89 years-old at diagnosis died of heart failure, one patient had fatal myocardial infarction which seemed to be unrelated to AS, and two patients had successful late AVR because of new heart failure. The low incidence of fatal cardiac events in asymptomatic patients with aortic stenosis and the relatively high possibility of developing non-cardiac events in elderly patients indicate that the decision-making for AVR should not be solely based upon the pressure gradient detected by Doppler echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)