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Original research article
Symptoms, disease severity and treatment of adults with a new diagnosis of severe aortic stenosis
  1. Norbert Frey1,
  2. Richard Paul Steeds2,
  3. Tanja K Rudolph3,
  4. Jeetendra Thambyrajah4,
  5. Antonio Serra5,
  6. Eberhard Schulz6,
  7. Jiri Maly7,
  8. Marco Aiello8,
  9. Guy Lloyd9,
  10. Alessandro Santo Bortone10,
  11. Karl Eugen Hauptmann11,
  12. Alberto Clerici12,
  13. Georg Delle Karth13,
  14. Johannes Rieber14,
  15. Ciro Indorfi15,
  16. Massimo Mancone16,
  17. Loic Belle17,
  18. Alexander Lauten18,
  19. Martin Arnold19,
  20. Berto J Bouma20,
  21. Matthias Lutz1,
  22. Christiane Pohlmann21,
  23. Jana Kurucova22,
  24. Martin Thoenes23,
  25. Peter Bramlage21,
  26. David Messika-Zeitoun24
  27. for the IMPULSE registry group
  1. 1Department of Cardiology and Angiology, University Medical Center Schleswig-Holstein, Kiel, Germany
  2. 2Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
  3. 3Heart Centre, University of Cologne, Cologne, Germany
  4. 4Cardiothoracic Division, James Cook Hospital, Middlesbrough, UK
  5. 5Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
  6. 6Kardiologie I, Universitätsmedizin der Johannes Gutenberg Universität Mainz, Mainz, Germany
  7. 7Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University, Prague, Czech Republic
  8. 8Cardiothoracic Surgery, Pavia University School of Medicine, Foundation IRCCS Policlinico S.Matteo, Pavia, Italy
  9. 9Cardiology/Cardiac Imaging, St Bartholomews Hospital, London, UK
  10. 10Division of Cardiovascular Surgery, University of Bari, Bari, Italy
  11. 11Abteilung für Innere Medizin 3, Krankenhaus der Barmherzigen Brüder, Trier, Germany
  12. 12Department of Cardiac Surgery, University of Turin, Turin, Italy
  13. 13Department of Internal Medicine/Cardiology, Hietzing Hospital, Vienna, Austria
  14. 14Department of Cardiology and Intensive Care Medicine, Heart Center Bogenhausen, Munich, Germany
  15. 15Department of Cardiology, Magna Graecia University, Catanzaro, Italy
  16. 16Department of Cardiovascular and Respiratory Disease, University of Rome La Sapienza, Rome, Italy
  17. 17Department of Cardiology, Annecy Hospital, Annecy, France
  18. 18Department of Cardiology, University Heart Center Berlin and Charite University Medicine Berlin, Campus Benjamin-Franklin, Berlin, Germany
  19. 19Cardiology Department, University of Erlangen, Erlangen, Germany
  20. 20AMC Heart Center, Academical Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  21. 21Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
  22. 22Edwards Lifesciences, Prague, Czech Republic
  23. 23Edwards Lifesciences, Nyon, Switzerland
  24. 24Heart Institute, University of Ottawa, Ottawa, Canada
  1. Correspondence to Professor Peter Bramlage, Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany ; submission{at}


Objective Contemporary data on patients with previously undiagnosed severe aortic stenosis (AS) are scarce. We aimed to address this gap by gathering data from consecutive patients diagnosed with severe AS on echocardiography.

Methods This was a prospective, multicentre, multinational, registry in 23 tertiary care hospitals across 9 European countries. Patients with a diagnosis of severe AS were included using echocardiography (aortic valve area (AVA) <1 cm2, indexed AVA <0.6 cm2/m2, maximum jet-velocity (Vmax) >4 m/s and/or mean transvalvular gradient >40 mm Hg).

Results The 2171 participants had a mean age of 77.9 years and 48.0% were female. The mean AVA was 0.73 cm2, Vmax4.3 m/s and mean gradient 47.1 mm Hg; 62.1% had left ventricular hypertrophy and 27.3% an ejection fraction (EF) <50%. 1743 patients (80.3%) were symptomatic (shortness-of-breath 91.0%; dizziness 30.2%, chest pain 28.9%). Patients had a EuroSCORE II of 4.0; 25.3% had a creatinine clearance <50 mL/min, and 3.2% had an EF <30%. Symptomatic patients were older and had more comorbidities than asymptomatic patients. Despite European Society of Cardiology 2017 valvular heart disease guideline class I recommendation, in only 76.2% a decision was made for an intervention (transcatheter 50.4%, surgical aortic valve replacement 25.8%). In asymptomatic patients, 57.7% with a class I/IIa indication were scheduled for a procedure, while 36.3% patients without an indication had their valve replaced.

Conclusions The majority of patients with severe AS presented at an advanced disease stage. Management of severe AS remained suboptimal in a significant proportion of contemporary patients with severe AS.

Trial registration number NCT02241447;Results.

  • aortic stenosis
  • transcatheter aortic valve replacement
  • surgical aortic valve replacement
  • symptoms
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  • Contributors NF, RPS, DM-Z, JK, MT and PB were involved in the conception and design of the study. NF, PB and DM-Z drafted the manuscript and all other authors revised the article for important intellectual content. All authors gave final approval of the version to be published.

  • Funding This work was supported by a research grant provided by Edwards Lifesciences (Nyon, Switzerland) to the Sponsor, the Institute for Pharmacology and Preventive Medicine (IPPMed, Cloppenburg, Germany).

  • Competing interests PB is the representative of the IPPMed. NF, RPS, TKR and DM-Z have received speakers’ honoraria from Edwards Lifesciences. The institutions of these three and those of the remaining authors representing study centers have received funding from the sponsor for employing a study nurse for the duration of the study. IPPMed designed and executed the study, collected and analysed the data and drafted/revised the manuscript in collaboration with the other authors.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon reasonable request.

  • Patient consent for publication Not required.

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