Clinical course of patients diagnosed with severe aortic stenosis in the Rotterdam area: insights from the AVARIJN study

Abstract

Objective To prospectively evaluate the clinical course of patients with severe aortic stenosis (AS) and identify factors associated with treatment selection and patient outcome. Methods Patients diagnosed with severe AS in the Rotterdam area were included between June 2006 and May 2009. Patient characteristics, echocardiogram, brain natriuretic peptide (NT-proBNP), and treatment strategy were assessed at baseline, and after 6, 12, and 24 months. Endpoints were aortic valve replacement (AVR) / transcatheter aortic valve implantation (TAVI) and death. Results The study population comprised 191 patients, 132 were symptomatic and 59 asymptomatic at study entry. Two-year cumulative survival of symptomatic patients was 89.8 % (95 % CI 79.8-95.0 %) after AVR/TAVI and 72.6 % (95 % CI 59.7-82.0 %) with conservative treatment. Twoyear cumulative survival of asymptomatic patients was 91.5 % (95 % CI 80.8-96.4 %). Two-year cumulative incidence of AVR/TAVI was 55.9 % (95 % CI 47.5-63.5 %) in symptomatic patients. Sixty-eight percent of asymptomatic patients developed symptoms, median time to symptoms was 13 months; AVR/TAVI cumulative incidence was 38.3 % (95 % CI 23.1-53.3 %). Elderly symptomatic patients with multiple comorbidities were more likely to receive conservative treatment. Conclusions In contemporary Dutch practice many symptomatic patients do not receive invasive treatment of severe AS. Two-thirds of asymptomatic patients develop symptoms within 2 years, illustrating the progressive nature of severe AS. Treatment optimisation may be achieved through careful individualised assessment in a multidisciplinary setting.

Symptomatic severe aortic stenosis in the TAVI era: heart team assessment for all

“…Confirming previous reports, this is shown by Heuvelman, van Geldorp and colleagues in the AVARIJN study [4]. They report that almost half of the patients with symptomatic severe AS do not undergo intervention, which may be an alarming finding.…”

“…A second important finding of the AVARIJN study is the progressive course of asymptomatic severe AS, with about two-thirds of patients becoming symptomatic within the 2-year follow-up period [4]. The timing of intervention in asymptomatic patients is still a matter of debate.…”

Dynamic prediction of outcome for patients with severe aortic stenosis: application of joint models for longitudinal and time-to-event data

“…We used the patient dataset of a previously reported prospective cohort study of 191 adult patients, who were diagnosed with severe aortic valve disease in seven cardiology clinics in the wider Rotterdam area between 2006 and 2009, and who were followed for 2 years [ 4 ]. Inclusion criteria were AVA ≤ 1 cm 2 , peak transaortic jet velocity (Vmax) ≥ 4 m/s, or aortic valve/left ventricular outflow tract velocity time integral ratio ≥ 4.…”

Quality of life among patients with severe aortic stenosis

“…This study is part of a recently published multi-centre prospective cohort study among patients with severe aortic stenosis in the Rotterdam area (the Netherlands) between July 2006 and April 2009 [17]. In short, patients with severe aortic stenosis were recruited from the echocardiography laboratories of the outpatient clinics of seven local hospitals and all consecutive patients who provided written informed consent were included, regardless of whether they were referred for surgery or not.…”