Syncope at rest in severe aortic stenosis may persist after intervention and is associated with poor outcomes

Abstract Background syncope in patients with severe aortic stenosis (AS) is an indication for intervention (AVR). The evolution of syncope after AVR and its association to outcomes remain unknown. Purpose we aimed to describe the evolution of syncope in patients with symptomatic severe AS undergoing AVR, whether its trigger has an impact on outcomes, and its prognostic significance. Methods data from patients with severe AS who underwent AVR were collected. Total death and cardiovascular death were considered events. Results 320 consecutive patients with severe AS, without other valve disease and/or coronary artery disease, who survived AVR were evaluated. The work focuses on the 53 patients who reported syncope (29 on effort, 21 at rest, 3 unknown). Clinical and echocardiographic variables were similar in patients with syncope and without syncope. After a median follow-up of 69 months (IQR: 55-88), no patient with syncope on effort before intervention had syncope after intervention. By contrast, 8 of the 21 patients with syncope at rest presented syncope during the follow-up (38%; p<0.001); all 8 syncopes appeared at rest: 3 needed a pacemaker, 3 were diagnosed as neuromediated or of hypotensive origin and 2 were arrhythmic. Only syncope after intervention was associated with cardiovascular death (HR 5.74; 95%CI [2.17-15.17]; p<0,001]). Conclusions syncope on effort in patients with severe AS disappears after AVR but syncope at rest remains in a high proportion of patients. Syncope after AVR is associated with poor prognosis. Our results suggest that, in patients with severe AS and syncope at rest, other causes of syncope must be ruled out before proceeding to AVR.Adjusted Kaplan Meier survival curves