Patients were classified into 1 category, including dyspnea, angina, syncope, and HF, according to their initial symptom. LV systolic dysfunction was defined as left ventricular ejection fraction (LVEF) less than 50%, and structural heart disease defined as previous diagnosis of ischemic heart disease, dilated cardiomyopathy, valve dysfunction (mild valvular stenosis and regurgitation were not included), or primary myocardial structural disease. The presence of heart failure (HF) was defined with signs or symptoms of HF with either pulmonary congestion, or objective findings of left ventricular (LV) systolic dysfunction or structural heart disease.
CAD was identified with a history of myocardial infarction, percutaneous coronary intervention, or angiographically documented coronary artery stenosis. Diabetes was defined as the use of hypoglycemic agents or fasting glucose level >126 mg/dL and/or 200 mg/dL at 2 hours after meal. Hypertension was defined with the use of antihypertensive medications or average office blood pressure >140–90 mmHg. We excluded patients without symptoms, patients who underwent surgical or percutaneous AVR within 6 months interval from the diagnosis, patients with concomitant moderate to severe valvular diseases other than AS and patients with other obvious causes of developing symptoms other than AS.īaseline clinical data were collected from their medical records including age, sex, history of hypertension, diabetes and presence of coronary artery diseases (CADs). We included all elderly patients (age over 65 years old) with symptomatic AS who refused undertaking AVR and treated conservatively. We screened all severe AS from January 2005 to December 2016.
This is a retrospective observational study in three tertiary referral hospitals in Korea. So, we investigated long-term clinical outcomes of elderly patients with symptomatic severe AS who refused taking AVR. However, we have no long-term prognosis data about these patients. Thus, there should be many elderly patients with symptomatic AS who treated with medically. However, the transcatheter aortic valve replacement (TAVR) has not been covered by the National Health Insurance Service in Korea, and TAVR has been performed in limited cases. Moreover, there can be a substantial number of symptomatic elderly AS patients who requiring AVR. 5) Because AV disease increases with aging, increasing aged-population would be associated with increase of its incidence in Korea. In Korea, prevalence of non-rheumatic degenerative AV disease was 72 patients per 100,000 persons. However, there are substantial portion of symptomatic AS patients who do not receive AVR for various reasons especially in elderly patients. 3), 4) Usually surgical or percutaneous aortic valve replacement (AVR) is the treatment of choice in patients with symptomatic AS. In the previous studies, symptom onset is major determinant of poor clinical outcomes in patients with severe AS. 1) In the US population-based study in 2005, the extrapolated prevalence of aortic valve (AV) disease was 1.8% (approximately 5.2 million people) and the prevalence was 10.7% in persons aged ≥65 years. Multivariate analysis showed that age and anemia were significant prognostic factors for cardiac and all-cause mortality.Īortic stenosis (AS) is the most common valvular heart disease especially in elderly patients and its incidence is growing with the increase of elderly population.
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). Their all-cause mortality and cardiac mortality were significantly higher than those of controls. Of them, 87 died from cardiac causes, and 1-, 3-, and 5-year cardiac mortality rate was 18.0☒.9%, 38.2☓.8%, and 50.7±4.3%, respectively. Total 102 patients died during follow-up period (39.1☓1.0 months). Calculated aortic stenosis area was 0.73☐.20 cm 2 and mean left ventricular ejection fraction (LVEF) was 57.8☑2.2%.
Hypertension was the most common cardiovascular risk factor (72%) and the most common symptom was dyspnea (66%). After screening of total 534 patients, we analyzed total 180 severe symptomatic AS patients (78☗ years old, 96 males).