Outcomes in asymptomatic, severe aortic stenosis

被引:12
|
作者
Kvaslerud, Anette Borger [1 ,2 ,3 ,4 ]
Santic, Kenan [1 ]
Hussain, Amjad Iqbal [2 ,3 ,4 ]
Auensen, Andreas [1 ,2 ,3 ,4 ]
Fiane, Arnt [1 ,5 ]
Skulstad, Helge [1 ,2 ]
Aaberge, Lars [2 ]
Gullestad, Lars [1 ,2 ,3 ,4 ]
Broch, Kaspar [2 ,3 ,4 ]
机构
[1] Univ Oslo, Fac Med, Oslo, Norway
[2] Oslo Univ Hosp, Rikshosp, Dept Cardiol, Oslo, Norway
[3] Oslo Univ Hosp, KG Jebsen Cardiac Res Ctr, Ulleval, Norway
[4] Oslo Univ Hosp, Ctr Heart Failure Res, Ulleval, Norway
[5] Oslo Univ Hosp, Rikshosp, Dept Cardiothorac Surg, Oslo, Norway
来源
PLOS ONE | 2021年 / 16卷 / 04期
关键词
VALVULAR HEART-DISEASE; NATURAL-HISTORY; GUIDELINES; MANAGEMENT; SURGERY; ADULTS;
D O I
10.1371/journal.pone.0249610
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background and aim of the study Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of contemporary patients advised against aortic valve replacement due to a perceived lack of symptoms. Materials and methods We reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec 1(st), 2002 and Dec 31(st), 2016. Patients who were evaluated by the heart team due to severe aortic stenosis were categorized by treatment strategy. We recorded baseline data, adverse events and survival for the patients characterized as asymptomatic and for 100 age and gender matched patients scheduled for aortic valve replacement. Results Of 2341 patients who were evaluated for aortic valve replacement due to severe aortic stenosis, 114 patients received conservative treatment due to a lack of symptoms. Asymptomatic patients had higher mortality than patients who had aortic valve replacement, log-rank p<0.001 (mean follow-up time: 4.0 (SD: 2.5) years). Survival at 1, 2 and 3 years for the asymptomatic patients was 88%, 75% and 63%, compared with 92%, 83% and 78% in the matched patients scheduled for aortic valve replacement. 28 (25%) of the asymptomatic patients had aortic valve replacement during follow-up. Age, previous history of coronary artery disease and N-terminal pro B-type natriuretic peptide (NT-proBNP) were predictors of mortality and coronary artery disease and NT-proBNP were predictors of 3-year morbidity in asymptomatic patients. Conclusions In this retrospective study, asymptomatic patients with severe aortic stenosis who were advised against surgery had significantly higher mortality than patients who had aortic valve replacement.
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页数:13
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