Prognostic implications in patients with symptomatic aortic stenosis and preserved ejection fraction: Japanese multicenter aortic stenosis, retrospective (JUST-R) registry.

Background Current prognostic implication of symptomatic patients with aortic stenosis (AS) remains undetermined. This study investigated the current prognostic implications of AS-related symptoms and the effect of aortic valve replacement (AVR) on outcome. Methods We enrolled 586 consecutive patients with severe AS (aortic valve area <1.0 cm 2 ) with preserved left ventricular ejection fraction (≥50%). All patients were stratified into the following four groups based on the predominant symptoms: Group 1, asymptomatic ( n = 316); Group 2, chest pain ( n = 41); Group 3, heart failure ( n = 192); or Group 4, syncope ( n = 37). Results AS-related symptoms were diagnosed in 270 patients (46.1%), among whom 182 patients (32.2%) received AVR. Thirty-nine patients (6.7%) had cardiac death during the mean follow-up of 16 ± 14 months. AVR was associated with significant reduction in cardiac death in Groups 3 ( p < 0.001) and 4 ( p = 0.004) whereas no significant prognostic advantage of AVR was observed in Groups 1 or 2. Cox proportional-hazard multivariate analysis revealed that age, heart failure, and mean pressure gradient (PG) were associated with increased risk of cardiac death in all patients regardless of AVR [hazard ratio (HR): 1.079, 2.090, and 1.008 respectively, all p < 0.05]. In the patients without AVR, age, heart failure, syncope, and mean PG were independently associated with cardiac death (HR: 1.130, 3.639, 4.638, and 1.008, all p < 0.05). Conclusion This retrospective study demonstrated the current associations between the types of AS symptoms and prognosis in Japanese patients with severe AS. [ABSTRACT FROM AUTHOR]