Aortic valve stenosis in community medical practice: Determinants of outcome and implications for aortic valve replacement Joseph Malouf, MD, Thierry.

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Presentation transcript:

Aortic valve stenosis in community medical practice: Determinants of outcome and implications for aortic valve replacement Joseph Malouf, MD, Thierry Le Tourneau, MD, Patricia Pellikka, MD, Thoralf M. Sundt, MD, Christopher Scott, MS, Hartzell V. Schaff, MD, Maurice Enriquez-Sarano, MD The Journal of Thoracic and Cardiovascular Surgery Volume 144, Issue 6, Pages 1421-1427 (December 2012) DOI: 10.1016/j.jtcvs.2011.09.075 Copyright © 2012 Terms and Conditions

Figure 1 Survival during medical management of Olmsted County, Minnesota, residents after the diagnosis of aortic stenosis (AS) according to baseline aortic valve area (AVA). The numbers along each curve indicate the survival at 5 and 8 years. Note the excess mortality associated with an AVA less than 1.0 cm2. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 1421-1427DOI: (10.1016/j.jtcvs.2011.09.075) Copyright © 2012 Terms and Conditions

Figure 2 Survival during medical management in Olmsted County, Minnesota, residents after diagnosis of aortic stenosis (AS) compared with the expected survival specific to each subset, according to aortic valve area (AVA) (<1.0 or ≥1.0 cm2) and functional class at diagnosis. Left, patients in functional class I (no angina or dyspnea); Middle, patients in class II (minimal angina or dyspnea); and Right, patients in class III-IV (severe angina or dyspnea). Observed survival (thick line) and expected survival (thin line) shown with 5-year rates indicated (bold, observed; thin italicized, expected), and P values refer to their comparison. Note, that class III-IV symptoms were associated with excess mortality, irrespective of AS severity. Also, patients with AVA less than 1.0 cm2 incurred excess mortality compared with that expected in those with severe, minimal, or even absent symptoms of angina and dyspnea. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 1421-1427DOI: (10.1016/j.jtcvs.2011.09.075) Copyright © 2012 Terms and Conditions

Figure 3 Incidence of congestive heart failure (CHF) during medical management in Olmsted County, Minnesota, residents after the diagnosis of aortic stenosis (AS) according to the baseline aortic valve area (AVA). The numbers along each curve indicate the rates of heart failure at 5 and 8 years. Note the excess heart failure incidence associated with an AVA less than 1.0 cm2. The Journal of Thoracic and Cardiovascular Surgery 2012 144, 1421-1427DOI: (10.1016/j.jtcvs.2011.09.075) Copyright © 2012 Terms and Conditions