OBJECTIVE: Contemporary data on patients with previously undiagnosed severe aortic stenosis (AS) are scarce. We aimed to address this gap by gathering data from consecutive patients diagnosed with severe AS on echocardiography. METHODS: This was a prospective, multicentre, multinational, registry in 23 tertiary care hospitals across 9 European countries. Patients with a diagnosis of severe AS were included using echocardiography (aortic valve area (AVA) <1 cm2, indexed AVA <0.6 cm2/m2, maximum jet-velocity (Vmax) >4 m/s and/or mean transvalvular gradient >40 mm Hg). RESULTS: The 2171 participants had a mean age of 77.9 years and 48.0% were female. The mean AVA was 0.73 cm2, Vmax4.3 m/s and mean gradient 47.1 mm Hg; 62.1% had left ventricular hypertrophy and 27.3% an ejection fraction (EF) <50%. 1743 patients (80.3%) were symptomatic (shortness-of-breath 91.0%; dizziness 30.2%, chest pain 28.9%). Patients had a EuroSCORE II of 4.0; 25.3% had a creatinine clearance <50 mL/min, and 3.2% had an EF <30%. Symptomatic patients were older and had more comorbidities than asymptomatic patients. Despite European Society of Cardiology 2017 valvular heart disease guideline class I recommendation, in only 76.2% a decision was made for an intervention (transcatheter 50.4%, surgical aortic valve replacement 25.8%). In asymptomatic patients, 57.7% with a class I/IIa indication were scheduled for a procedure, while 36.3% patients without an indication had their valve replaced. CONCLUSIONS: The majority of patients with severe AS presented at an advanced disease stage. Management of severe AS remained suboptimal in a significant proportion of contemporary patients with severe AS. TRIAL REGISTRATION NUMBER: NCT02241447;Results.

Abteilung für Innere Medizin 3 Krankenhaus der Barmherzigen Brüder Trier Germany

AMC Heart Center Academical Medical Center University of Amsterdam Amsterdam The Netherlands

Cardiology Cardiac Imaging St Bartholomews Hospital London UK

Cardiology Department University of Erlangen Erlangen Germany

Cardiothoracic Division James Cook Hospital Middlesbrough UK

Cardiothoracic Surgery Pavia University School of Medicine Foundation IRCCS Policlinico S Matteo Pavia Italy

Department of Cardiac Surgery University of Turin Turin Italy

Department of Cardiology and Angiology University Medical Center Schleswig Holstein Kiel Germany

Department of Cardiology and Intensive Care Medicine Heart Center Bogenhausen Munich Germany

Department of Cardiology Annecy Hospital Annecy France

Department of Cardiology Hospital de la Santa Creu i Sant Pau Barcelona Spain

Department of Cardiology Magna Graecia University Catanzaro Italy

Department of Cardiology Queen Elizabeth Hospital Birmingham UK

Department of Cardiology University Heart Center Berlin and Charite University Medicine Berlin Campus Benjamin Franklin Berlin Germany

Department of Cardiovascular and Respiratory Disease University of Rome La Sapienza Rome Italy

Department of Cardiovascular Surgery 2nd Faculty of Medicine Charles University Prague Czech Republic

Department of Internal Medicine Cardiology Hietzing Hospital Vienna Austria

Division of Cardiovascular Surgery University of Bari Bari Italy

Edwards Lifesciences Nyon Switzerland

Edwards Lifesciences Prague Czech Republic

Heart Centre University of Cologne Cologne Germany

Heart Institute University of Ottawa Ottawa Canada

Institute for Pharmacology and Preventive Medicine Cloppenburg Germany

Kardiologie 1 Universitätsmedizin der Johannes Gutenberg Universität Mainz Mainz Germany

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Heart. 2019 Nov;105(22):1686-1687. doi: 10.1136/heartjnl-2019-315606. PubMed

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ClinicalTrials.gov
NCT02241447