Association of Mortality With Aortic Stenosis Severity in Outpatients
Authors: Augustin Coisne, David Montaigne, Samy Aghezzaf, Hélène Ridon, Stéphanie Mouton, Marjorie Richardson, Anne-Sophie Polge, Patrizio Lancellotti, Christophe Bauters, Luc Abramovici, Jean-Charles Aisenfarb, Moulay Alaoui, Ahmed Amiar, Mariam Arabidze, Valérie Aumegeat, Laurence Avez-Lemaire, Hélène Bardet, Karine Bauley, Jean Becquart, Aida Ben Abda, Frédéric Biausque, Fanny Boudghene Stambouli, Bertrand Boutié, Damien Broucqsault, Jean-Michel Bruffau, Benoit Brullard, Laurent Carpentier, Sébastien Caudmont, Karim Chachoua, Akram Chmait, Maïwenn Clement-Dupont, Christophe Cordier, Alessandro Cosenza, Jean-Pierre Coulomb, Vladimir Cousin, Elise Dassonvalle, Guillaume de Geeter, Pascal de Groote, Eric Decoulx, Maxence Delomez, Pascal Delsart, François Destombes, Nicolas Detis, Michel Devillers, Olivia Domanski, Audrey Duchemin, Xavier Dujardin, Anju Duva Pentiah, Nima Endjah, Octave Equine, Marie Fertin, Bruno Fournier, Dauphine Garin, Antonio Gongora, Lorraine Greffe, Gery Hannebicque, Jérôme Haye, Eléonore Hebbar, Vincent Hennebelle, Olivier Hennebert, Gérard Houdain, Arnaud Hubert, Charles Hudelo, Thibault Hus, Olivier Jabourek, Mathilde Jacquelinet, Thierry Jacquemart, Belaid Jellouli, Antoine Jeu, Messaoud Kouidri, Francis Kozlowski, Robert Lallemant, Nicolas Lamblin, Patricia Langlois, Guillaume Ledieu, Yann Lefetz, Philippe Lejeune, François Leleu, Nestor Lemaire, Rémy Lubret, Anne-Laure Madika, Philippe Marboeuf, Thibaud Meurice, Jonathan Meurice, Alain Millaire, Frédéric Mouquet, Aurélie Musschoot, Christophe Mycinski, Dan Neicu, Olivier Nugue, Rahma Ouardani, Karima Ouchallal, François Passard, Max Pecheux, Karine Pedelhez, Alain Petit, André Philias, Rosario Pilato, Philippe Pruvost, Arnaud Quercy, Marc Sagot, Karine Sautiere-Tricot, Christine Savoye, Benoit Segrestin, Kouroch Taghipour, Véronique Taverne, Dieudonné Tchatchoua, Sylvie Tondeux, Olivier Tricot, Arthur Vaksmann, Dominique Vandamme, Claire Vanesson, Bruno Vaquette, Eric Verbrugge, Mathieu Verhaeghe, Rémy Viart, Hubert Vodoungnon, Julien Voyez, Steve Werquin, Maud Wibaux
Journal: JAMA Cardiology (2021)

<h3>Importance</h3> Modern data regarding incidence and modes of death of patients with aortic stenosis (AS) are restricted to tertiary centers or studies of aortic valve replacement (AVR). <h3>Objective</h3> To provide new insights into the natural history of outpatients with native AS based on a large regionwide population study with inclusion by all cardiologists regardless of their mode of practice. <h3>Design, Setting, and Participants</h3> Between May 2016 and December 2017, consecutive outpatients with mild (peak aortic velocity, 2.5-2.9 m/s), moderate (peak aortic velocity, 3-3.9 m/s), and severe (peak aortic velocity, ≥4 m/s) native AS graded by echocardiography were included by 117 cardiologists from the Nord-Pas-de-Calais region in France. Analysis took place between August and November 2020. <h3>Main Outcomes and Measures</h3> Natural history, need for AVR, and survival of patients with AS were followed up. Indications for AVR were based on current guideline recommendations. <h3>Results</h3> Among 2703 patients (mean [SD] age, 76.0 [10.8] years; 1260 [46.6%] women), 233 (8.6%) were recruited in a university public hospital, 757 (28%) in nonuniversity public hospitals, and 1713 (63.4%) by cardiologists working in private practice. A total of 1154 patients (42.7%) had mild, 1122 (41.5%) had moderate, and 427 (15.8%) had severe AS. During a median (interquartile range) of 2.1 (1.4-2.7) years, 634 patients underwent AVR and 448 died prior to AVR. Most deaths were cardiovascular (200 [44.7%]), mainly associated with congestive heart failure (101 [22.6%]) or sudden death (60 [13.4%]). Deaths were noncardiovascular in 186 patients (41.5%) and from unknown causes in 62 patients (13.8%). Compared with patients with mild AS, there was increased cardiovascular mortality in those with moderate (hazard ratio, 1.47 [95% CI, 1.07-2.02]) and severe (hazard ratio, 3.66 [95% CI, 2.52-5.31]) AS. The differences remained significant when adjusted for baseline characteristics or in time-dependent analyses considering AS progression. In asymptomatic patients, moderate and mild AS were associated with similar cardiovascular mortality (hazard ratio, 0.99 [95% CI, 0.44-2.21]). <h3>Conclusions and Relevance</h3> While patients in this study with moderate AS had a slightly higher risk of cardiovascular death than patients with mild AS, this risk was much lower than that observed in patients with severe AS. Moreover, in asymptomatic patients, moderate and mild AS were associated with similar cardiovascular mortality.