Korean Circ J.  2019 Feb;49(2):160-169. 10.4070/kcj.2018.0208.

Long-term Survival in Korean Elderly Patients with Symptomatic Severe Aortic Stenosis Who Refused Aortic Valve Replacement

• Oh JK
• Park JH
• Hwang JK
• Lee CH
• Park JS
• Park JI
• Park HK
• Cho JS
• Seo BS
• Seong SW
• Sun BJ
• Lee JH
• Seong IW

• KMID: 2432133
• DOI: http://doi.org/10.4070/kcj.2018.0208

Abstract

BACKGROUND AND OBJECTIVES
Aortic valve replacement (AVR) is the treatment of choice in severe symptomatic aortic stenosis (AS) patients. However, a substantial number of elderly patients refuse AVR and treated medically. We investigated their long-term prognosis.
METHODS
From January 2005 to December 2016, we analyzed elderly patients with severe symptomatic AS who refused to have AVR.
RESULTS
After screening of total 534 patients, we analyzed total 180 severe symptomatic AS patients (78±7 years old, 96 males). Hypertension was the most common cardiovascular risk factor (72%) and the most common symptom was dyspnea (66%). Calculated aortic stenosis area was 0.73±0.20 cm2 and mean left ventricular ejection fraction (LVEF) was 57.8±12.2%. Total 102 patients died during follow-up period (39.1±31.0 months). One-, 3-, and 5-year all-cause mortality rate was 21.1±3.0%, 43.1±3.8%, and 56.5±4.2%, respectively. Of them, 87 died from cardiac causes, and 1-, 3-, and 5-year cardiac mortality rate was 18.0±2.9%, 38.2±3.8%, and 50.7±4.3%, respectively. Their all-cause mortality and cardiac mortality were significantly higher than those of controls. Univariate analysis showed that age, anemia, LVEF, and Log N-terminal pro B-type natriuretic peptide (NT-proBNP) were significant parameters in all-cause mortality (p < 0.001, p=0.001, p=0.039, and p=0.047, respectively) and in cardiac mortality (p < 0.001, p < 0.001, p=0.046, and p=0.026, respectively). Multivariate analysis showed that age and anemia were significant prognostic factors for cardiac and all-cause mortality.
CONCLUSIONS
In elderly severe symptomatic AS patients who treated medically, their 1-, 3- and 5-year all-cause mortality rate was 21.1±3.0%, 43.1±3.8%, and 56.5±4.2%, respectively. Age and anemia were significant prognostic factors for cardiac and all-cause mortality.

Keyword

Aortic valve stenosis; Survival; Prognosis; Drug therapy

MeSH Terms

Aged*
Anemia
Aortic Valve Stenosis*
Aortic Valve*
Drug Therapy
Dyspnea
Follow-Up Studies
Humans
Hypertension
Mass Screening
Mortality
Multivariate Analysis
Natriuretic Peptide, Brain
Prognosis
Risk Factors
Stroke Volume
Natriuretic Peptide, Brain

Figure

• 

  Figure 1 Scheme of study population. AS = aortic stenosis; SAVR = surgical aortic valve replacement; TAVR = transcatheter aortic valve replacement.

• 

  Figure 2 All-cause mortality and cardiac mortality. One-, 3- and 5-year mortality rate is 21.1±3.0%, 43.1±3.8% and 56.5±4.2%, respectively (A) All-cause mortality of our study population is much higher than that of normal controls (1-, 3-, and 5-year survival rate was 1.3±0.4%, 11.4±1.0%, and 25.7±1.4%, respectively (p<0.001, p=0.010, and p=0.014, respectively). One-, 3- and 5-year cardiac mortality rate is 18.0±2.9%, 38.2±3.8% and 50.7±4.3%, respectively (B). Which is much higher than that of normal controls (1-, 3-, and 5-year survival rate was 0.2±0.1%, 3.0±0.6%, and 6.4±0.8%, respectively (p=0.005, p=0.008, and p=0.010, respectively). Sx AS = symptomatic aortic stenosis.

• 

  Figure 3 All-cause mortality (A) and cardiac mortality (B) according to their initial presenting symptoms. There is no significant difference among groups in all-cause mortality (p=0.415) and cardiac mortality (p=0.767). HF = heart failure.

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  Figure 4 All-cause mortality (A) and cardiac mortality (B) according to PG and LVEF, such as HGpEF, HGrEF, LGpEF, and LGrEF. There is no significant difference among the 4 groups in all-cause mortality and cardiac mortality. HGpEF = high gradient severe aortic stenosis with preserved left ventricular ejection fraction; HGrEF = high gradient severe aortic stenosis with reduced left ventricular ejection fraction; LGpEF = low gradient severe aortic stenosis with preserved left ventricular ejection fraction; LGrEF = low gradient severe aortic stenosis with reduced left ventricular ejection fraction; LVEF = left ventricular ejection fraction; PG = pressure gradient.

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