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

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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. Two-year 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.

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Acknowledgements

The authors would like to thank the patients and colleagues of the participating hospitals for their enthusiastic collaboration: Albert Schweitzer Ziekenhuis, Erasmus University Medical Center, Havenziekenhuis, Maasstad Ziekenhuis, Sint Franciscus Gasthuis, Vlietland Ziekenhuis, and IJsselland Ziekenhuis.

Conflict of interest

None declared.

Author information

Authors and Affiliations

  1. Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands

    H. J. Heuvelman, M. W. A. van Geldorp, A. P. Kappetein, A. J. J. C. Bogers & J. J. M. Takkenberg

  2. Department of Cardiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, the Netherlands

    M. L. Geleijnse & T. W. Galema

  3. Cardiology Club Rijnmond, Dordrecht, the Netherlands

    M. L. Geleijnse & T. W. Galema

Authors
  1. H. J. Heuvelman
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  2. M. W. A. van Geldorp
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  3. A. P. Kappetein
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  4. M. L. Geleijnse
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  5. T. W. Galema
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  6. A. J. J. C. Bogers
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  7. J. J. M. Takkenberg
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Corresponding author

Correspondence to H. J. Heuvelman.

Additional information

Helena J. Heuvelman and Martijn W. A. van Geldorp have equally contributed to this work.

Appendix: Definitions

Appendix: Definitions

Body surface area:

calculated with DuBois and DuBois formula.

Carotid disease:

stenosis >50 %, or previous or planned surgery.

Chronic obstructive pulmonary disease:

diagnosis previously made by physician, or receiving bronchodilators.

Congestive heart failure:

hospital stay with clinical sign(s) of congestive heart failure.

Coronary artery disease:

>50 % stenosis in at least one coronary artery proved by coronary angiography, or previously coronary artery bypass grafting.

Diabetes:

diagnosis previously made by physician, or receiving blood glucose-lowering medication.

Dyslipidaemia:

diagnosis previously made by physician, or receiving lipid-lowering medication.

Hypertension:

diagnosis previously made by physician, or known blood pressure of ≥140 mmHg systolic or ≥90 mmHg diastolic on at least two measurements, or receiving blood pressure-lowering medication.

Ischaemia:

ST depression ≥1 mm at J + 60 ms in at least two electrocardiographic leads.

Left ventricular hypertrophy:

S in V1 plus R in V5/V6 > 35 mm, R in V6 > R in V5, R in I and/or aVL > 12 mm on electrocardiography at J + 60 ms.

Myocardial infarction:

diagnosis previously made by physician.

Peripheral arterial disease:

claudication, or previous or planned surgery of the lower limbs.

Renal failure:

diagnosis previously made by physician or creatinine ≥200 μmol/l.

Smoking:

smoking cigarettes or cigars for ≥5 years in the past.

Stroke:

diagnosis ‘transient ischaemic attack’ or ‘cerebrovascular accident’ previously made by physician, or neurological disease severely affecting ambulation or day-to-day functioning.

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Heuvelman, H.J., van Geldorp, M.W.A., Kappetein, A.P. et al. Clinical course of patients diagnosed with severe aortic stenosis in the Rotterdam area: insights from the AVARIJN study. Neth Heart J 20, 487–493 (2012). https://doi.org/10.1007/s12471-012-0309-3

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  • DOI: https://doi.org/10.1007/s12471-012-0309-3

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