615 Symptomatic status and outcomes in a real-world severe aortic stenosis population

Abstract Introduction Aortic stenosis (AS) is one of the most common valvular heart diseases and is now frequently diagnosed in asymptomatic patients (AP). Symptomatic patients (SP) have a higher risk of adverse events, in contrast with AP. The current guidelines recommend aortic valve replacement (AVR) for SP with severe AS (SAS), with a very poor prognosis for those conservatively managed. Purpose To evaluate the baseline characteristics, therapeutic strategies and the long-term outcomes of SP and AP with SAS in a real­-world setting. Methods Retrospective cohort study of AP and SP with SAS (mean transvalvular pressure gradient (MG) > =40 mmHg or a peak transvalvular velocity (PTV) > =4.0 m/s), who were examined in our echo lab between January 2014 and December 2016. Follow-up was 2.6 ± 1.0 years. The primary outcome was a composite of cardiovascular death or heart failure hospitalization. Results 212 patients (pts) with SAS were included (age 76.1 ± 9.1years, 31.6% men; aortic valve area 0.69 ± 0.21cm2; PTV 4.5 ± 0.4m/s; MG 48.5 ± 11.6mmHg; left ventricular ejection fraction 58.8 ± 12.2%). 154 pts (72.6%) had symptoms related to aortic stenosis. The SP had higher PTV (4.6 ± 0.5 vs 4.3 ± 0.4m/s, p < 0.0001) and MG (50.4 ± 12.2 vs 43.5 ± 7.8mmHg, p < 0.0001), less peripheral artery disease (2.6% vs 12.1%, p = 0.011), more chronic obstructive pulmonary disease (13.0% vs 1.8%, p = 0.016) and arterial hypertension (74.0% vs 56.0%, p = 0.016). AVR (surgical n = 99, transcatheter n = 13) was performed in 47.6% (n = 101) SP and 19.0% (n = 11) AP (p < 0.0001), while the remainder with a formal indication (n = 70, 33.0%) were managed conservatively. Twelve AP (36.2%) did not undergo AVR, although they had indication (4 refused, 4 due to comorbidities and 4 died). The AVR was not performed in the SP group mostly due to comorbidities (n = 23, 14.9%) and refusal (n = 22, 14.3%). Forty-four pts (20.8%) had at least one event of the primary outcome and there were no differences in the SP and AP groups (n = 36, 23.4% in SP vs n = 8, 13.4% in AP, p = 0.125). However, SP and AP who underwent to AVR had fewer events (Figure 1). Pts with at least one event were mainly female (54.5%, p = 0.026), hadn’t performed AVR (84.1% vs 15.9%, p < 0.0001), had a lower estimated glomerular filtration rate (58.4 ± 21.2 vs 66.3 ± 21.4mL/min/1.73m2, p = 0.03), higher systolic pulmonary artery pressure (45.4 ± 17.3 vs 37.8 ± 14.9mmHg, p = 0.016) and lower TAPSE (20.2 ± 4.9 vs 22.4 ± 4.2mm, p = 0.012). In the multivariate analysis, only the AVR was predictive of the outcome (HR 0.079, CI 0.028-0.227, p < 0.0001). Conclusion In a real-world experience, SAS has a high rate of adverse events. Few differences were observed between SP and AP. The AVR had a significant impact in the outcome, regardless of symptoms, thus implying that selected AP may as well benefit from this intervention. Nonetheless, in a real-world setting, more than one-third of the pts with a formal indication for intervention was conservatively treated. Abstract 615 Figure 1 Survival of SAS pts.