615 Symptomatic status and outcomes in a real-world severe aortic stenosis population
Authors: Ventura Gomes R , Pais J , Pereira A R , Sebaiti D , Cruz I , Almeida A R , Joao I , Pereira H 
Published: January 2020

Abstract

Introduction
Aortic stenosis (AS) is one of the most common valvular heart diseases and is now frequently diagnosed in asymptomatic patients (AP). Symptomatic patients (SP) have a higher risk of adverse events, in contrast with AP. The current guidelines recommend aortic valve replacement (AVR) for SP with severe AS (SAS), with a very poor prognosis for those conservatively managed.

Purpose
To evaluate the baseline characteristics, therapeutic strategies and the long-term outcomes of SP and AP with SAS in a real­-world setting.

Methods
Retrospective cohort study of AP and SP with SAS (mean transvalvular pressure gradient (MG) &gt; =40 mmHg or a peak transvalvular velocity (PTV) &gt; =4.0 m/s), who were examined in our echo lab between January 2014 and December 2016. Follow-up was 2.6 ± 1.0 years.
The primary outcome was a composite of cardiovascular death or heart failure hospitalization.

Results
212 patients (pts) with SAS were included (age 76.1 ± 9.1years, 31.6% men; aortic valve area 0.69 ± 0.21cm2; PTV 4.5 ± 0.4m/s; MG 48.5 ± 11.6mmHg; left ventricular ejection fraction 58.8 ± 12.2%).
154 pts (72.6%) had symptoms related to aortic stenosis. The SP had higher PTV (4.6 ± 0.5 vs 4.3 ± 0.4m/s, p &lt; 0.0001) and MG (50.4 ± 12.2 vs 43.5 ± 7.8mmHg, p &lt; 0.0001), less peripheral artery disease (2.6% vs 12.1%, p = 0.011), more chronic obstructive pulmonary disease (13.0% vs 1.8%, p = 0.016) and arterial hypertension (74.0% vs 56.0%, p = 0.016).
AVR (surgical n = 99, transcatheter n = 13) was performed in 47.6% (n = 101) SP and 19.0% (n = 11) AP (p &lt; 0.0001), while the remainder with a formal indication (n = 70, 33.0%) were managed conservatively. Twelve AP (36.2%) did not undergo AVR, although they had indication (4 refused, 4 due to comorbidities and 4 died). The AVR was not performed in the SP group mostly due to comorbidities (n = 23, 14.9%) and refusal (n = 22, 14.3%).
Forty-four pts (20.8%) had at least one event of the primary outcome and there were no differences in the SP and AP groups (n = 36, 23.4% in SP vs n = 8, 13.4% in AP, p = 0.125). However, SP and AP who underwent to AVR had fewer events (Figure 1).
Pts with at least one event were mainly female (54.5%, p = 0.026), hadn’t performed AVR (84.1% vs 15.9%, p &lt; 0.0001), had a lower estimated glomerular filtration rate (58.4 ± 21.2 vs 66.3 ± 21.4mL/min/1.73m2, p = 0.03), higher systolic pulmonary artery pressure (45.4 ± 17.3 vs 37.8 ± 14.9mmHg, p = 0.016) and lower TAPSE (20.2 ± 4.9 vs 22.4 ± 4.2mm, p = 0.012). In the multivariate analysis, only the AVR was predictive of the outcome (HR 0.079, CI 0.028-0.227, p &lt; 0.0001).

Conclusion
In a real-world experience, SAS has a high rate of adverse events. Few differences were observed between SP and AP.
The AVR had a significant impact in the outcome, regardless of symptoms, thus implying that selected AP may as well benefit from this intervention. Nonetheless, in a real-world setting, more than one-third of the pts with a formal indication for intervention was conservatively treated.
Abstract 615 Figure 1 Survival of SAS pts.