Aortic valve replacement in asymptomatic individuals with severe aortic stenosis and left ventricular hypertrophy

Abstract Background The development of left ventricular hypertrophy (LVH) could indicate ventricular injury and potential need for earlier aortic valve replacement (AVR) in asymptomatic severe aortic stenosis (AS). In clinical guidelines, there is uncertainty regarding the management of asymptomatic individuals and potential signs of subclinical ventricular injury. We have previously found mortality reduction in individuals with severe AS and LVH but not in a cohort confirmed asymptomatic. Methods From a previously established registry of 4856 individuals with normal flow, severe AS, LVEF ≥ 55% and LVH, we identified asymptomatic individuals from physician chart review. To assess the association between AVR and mortality, Cox proportional hazards models were used with the index echocardiogram as time zero. To address immortal time bias, AVR was considered a time-varying covariate. Results After application of eligibility criteria, 607 unique asymptomatic individuals were analyzed. Of those, 335 (55.2%) received AVR with 41.2% receiving surgical AVR and 58.8% receiving transcatheter AVR. Individuals who received AVR had lower unadjusted mortality than those who did not receive AVR (12.8% vs. 58.5%, p 0.001). After adjustment and accounting for time-dependence of AVR, AVR was associated with reduced mortality (HR 0.37, 95% CI 0.25-0.55, p 0.001). Conclusions AVR was associated with reduced mortality in a dedicated cohort of patients confirmed asymptomatic after physician chart review with severe asymptomatic AS, preserved LVEF, and LVH.Survival in Asymptomatic Severe AS+LVH