30 Apr

The Natural History and Rate of Progression of Aortic Stenosis: Minimally Symptomatic or Asymptomatic Aortic Stenosis

The Natural History and Rate of Progression of Aortic Stenosis: Minimally Symptomatic or Asymptomatic Aortic StenosisThe debate concerning the treatment of asymptomatic patients with significant aortic stenosis has largely been settled through the following lines of evidence: In 1937, Contratto and Levine followed up 180 patients with valvular aortic stenosis over a 25-year period. They reported that sudden death occurred “rarely” in totally asymptomatic patients and was often preceded by the development of symptoms. In 1968, Ross and Braunwald, in their classic review of the natural history of aortic stenosis, reemphasized that sudden death occurred predominantly in symptomatic patients. In asymptomatic patients with acquired aortic stenosis, the risk of sudden death was reported to be between 3% and 5%. At this time, it was proposed that patients with acquired valvular aortic stenosis have surgery deferred until the onset of symptoms.
Now, three decades later, despite technological advancement allowing us to identify more occult valvular heart disease, the evidence continues to support this proposed conservative treatment of patients with asymptomatic acquired valvular aortic stenosis. mycanadianpharmacy.com

Turina et al retrospectively reviewed 73 patients with aortic stenosis in whom cardiac catheterization had been performed between 1963 and 1983. The severity of stenosis was primarily determined by the Gorlin-derived aortic valve area (<0.9 cm2 severe; 0.95 to 1.4 cm2 moderate; >1.5 cm2 mild). In 15 patients, the aortic valve area was not calculated. In these patients, mean pressure gradient was used to define the hemodynamic severity of the disease (>50 mm Hg severe, <20 mm Hg mild). In a group of 17 asymptomatic or mildly symptomatic patients with severe aortic stenosis or combined aortic stenosis and aortic regurgitation, none of the patients died or required valve surgery during the first 2 years. At 5 years, 75% were event free (alive and not had surgery) and 94% survived. In the group with moderate aortic disease, none of the asymptomatic or mildly symptomatic patients died, but 27% underwent valve surgery within 5 years. The actuarial survival in relation to New York Heart Association classification was 99% and 76% at 2 and 5 years, respectively, for patients with functional class I to II. In patients with functional class III to IV, the actuarial survival was 31% and 22% at 2 and 5 years, respectively. They concluded that asymptomatic or minimally symptomatic patients with severe aortic stenosis are at low risk of death and that surgical treatment can be postponed until “marked symptoms” appear.

Categories: Aortic Stenosis
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