Even moderate Aortic Stenosis carries high risk of sudden death/complications

Help Support ValveReplacement.org:

epstns

Premium User
VR.org Supporter
Joined
Dec 26, 2002
Messages
5,100
Location
Chicago area
I'm not so sure I'd jump onto that bandwagon, although I am only a sample size of one. I was diagnosed with moderate to severe AS, but did not progress to surgery for over 11 years, and I did just fine. Yes, there will be patients who suffer cardiac events related to AS, but prior studies showed that those events usually did not occur while the AS was categorized as less than critical. The point to keep in mind is that almost all AS patients will progress, so if they are diagnosed initially as moderate, they will almost certainly progress, if untreated, to severe, then critical. If left untreated, odds are that something bad will happen.

I may be very wrong, but I sort of see that study as a self-serving tool to herd more people into early intervention via TAVR, rather than waiting and having a traditional valve replacement.

Could we all have been "that" wrong for the past 30 years or so?
 

pellicle

Professional Dingbat
Joined
Nov 4, 2012
Messages
6,668
Location
Queensland, OzTrayLeeYa
but I sort of see that study as a self-serving tool to herd more people into early intervention via TAVR, rather than waiting and having a traditional valve replacement.
and I thought I was cynical (although as it happens I agree with you) ... spook the herd
 

pellicle

Professional Dingbat
Joined
Nov 4, 2012
Messages
6,668
Location
Queensland, OzTrayLeeYa
Firstly the name of the website: cardiovascular business ... right .... well phrased when you say:
Scary business
The actual study (and that site wanted to deposit a bunch of trackers on me) is here:

http://www.onlinejacc.org/content/74/15/1851

I didn't do the full read, just the results and conclusions. So I'll underline a few points of significance:

Methods Severity of AS was characterized by convention and by statistical distribution in 122,809 male patients (mean age 61 ± 17 years) and 118,494 female patients (mean age 62 ± 19 years), with measured aortic valve (AV) mean gradient, peak velocity, and/or area. The relationship between AS severity and survival was then examined during median 1,208 days (interquartile range: 598 to 2,177 days) of follow-up. Patients with previous aortic valve intervention were excluded.​
quite a variation ... and I'd prefer to also know the standard deviation ... like was there one 44 yo and one 78 year? Or perhaps one at +17 years and who knows what minus? ... and what was the distribution (biased towards older than 62, like 70?? I feel cautious about how anyone who doesn't make a good showing of their capacity in basics of statistics may be at interpreting the data (and I doubt that they are stats illiterate if you see what I mean).

Results Overall, 16,129 (6.7%), 3,315 (1.4%), and 6,383 (2.6%) patients had mild, moderate, and severe AS, respectively. On an adjusted basis (vs. no AS; 5-year mortality 19%), patients with mild to severe AS had an increasing risk of long-term mortality (adjusted hazard ratio: 1.44 to 2.09; p < 0.001 for all comparisons). The 5-year mortality was 56% and 67%, respectively, in those with moderate AS (mean gradient 20.0 to 39.0 mm Hg/peak velocity 3.0 to 3.9 m/s) and severe AS (≥40.0 mm Hg, ≥4.0 m/s, or AV area <1.0 cm2 in low-flow, low-gradient severe AS). A markedly increased risk of death from all causes (5-year mortality >50%) and cardiovascular disease was evident from a mean AV gradient >20.0 mm Hg (moderate AS) after adjusting for age, sex, left ventricular systolic or diastolic dysfunction, and aortic regurgitation.​
I would wonder what the 5 year mortality would be for a greater than 70 year old with heart issues (and what else?

Conclusions These data confirm that when left untreated, severe AS is associated with poor long-term survival. Moreover, they also suggest poor survival rates in patients with moderate AS. (National Echocardiographic Database of Australia [NEDA]; ACTRN12617001387314)​

Well myself I'd say anyone at 70 has poor long term survival. Its interesting that it was an Australian study.

Perhaps someone feels like making deeper observations and analysis.

Ultimately, I agree that surgery earlier is better than later, so if you feel anxious why not find a surgeon and get it done soon? Go for a mechanical and hedge your bets that you'll never need reoperation and have the added bonus that being on AC Therapy will probably lengthen your life anyway (like you can pretty much discount DVT or Stroke as a cause of death.
 

Astro

Well-known member
Joined
Aug 26, 2019
Messages
84
Location
Adelaide, Australia
I have read quite a few of the journal articles about this topic. Sudden death from moderate aortic stenosis is very low. Really not much different to the background population. Even with severe stenosis, provided that you don’t ignore symptoms and follow the cardiologist’s orders (don’t refuse surgery when they recommend it), the risk of sudden death is quite low.

Yes, complication risk goes up with increasing stenosis. Getting the valve replaced is generally viewed as a “complication” in these studies. Naturally, the risk of having the valve dealt with goes up with increasing stenosis. However, having the valve dealt with greatly reduces risk of sudden death.

Moderate aortic stenosis is a reason for vigilance because occasionally things change quicker than we would like. However, it can and normally is safely managed.

The point of the study was that people with moderate stenosis should be followed up by their cardiologist with regular echoes because things might change. It was not to have surgery with moderate stenosis.

I hope this helps. Moderate aortic stenosis = live life normally but also have regular occasional echoes.
 

Astro

Well-known member
Joined
Aug 26, 2019
Messages
84
Location
Adelaide, Australia
I have read the journal article. It is a large, carefully conducted, Australian trial. I see no evidence of any business bias. It appears to be a genuine study conducted to increase scientific knowledge. Echo data of several sites was collected into a huge database.

It is staggering in its size - 241,303 individuals who had an echo. 16,129 patients has mild AS; 3,315 had moderate AS; 6,383 had severe AS. Patients were categorised according to their initial echo and their survival was tracked with mortality database information (whether they subsequently died). This means that a patient whose initial echo was moderate (so categorised as moderate) may have progressed to severe (and also AVR) during the follow up. The moderate AS group had similar increased long-term mortality as the severe AS group. The authors suggested that the moderate AS mortality may be a reflection that many progressed to severe.

What does this mean? My interpretation is that significant aortic valve disease has a long-term impact on survival. There is still room for further medical development/improvement. We must remember that aortic stenosis's impact on mortality is vastly better than 50 years ago. There has been an incredible improvement and it will, no doubt, continue to improve.

The study certainly does not suggest that people with moderate AS should have surgery.
 

Latest posts



Top