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Original research
Sudden cardiac death in asymptomatic patients with aortic stenosis
  1. Jan Minners1,
  2. Anne Rossebo2,
  3. John B Chambers3,
  4. Christa Gohlke-Baerwolf1,
  5. Franz-Josef Neumann1,
  6. Kristian Wachtell2,
  7. Nikolaus Jander1
  1. 1Department of Cardiology and Angiology II, University Heart Center Freiburg / Bad Krozingen, Bad Krozingen, Germany
  2. 2Department of Cardiology, Oslo Universitetssykehus Rikshospitalet, Oslo, Norway
  3. 3St Thomas Hospital, London, UK
  1. Correspondence to Dr Jan Minners, Department of Cardiology and Angiology II, University Heart Center Freiburg / Bad Krozingen, Bad Krozingen, Germany; Jan.Minners{at}universitaets-herzzentrum.de

Abstract

Objective We retrospectively analysed outcome data from the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study to assess the incidence and potential risk factors of sudden cardiac death (SCD) in this prospectively followed cohort of asymptomatic patients with aortic stenosis (AS).

Methods Of the 1873 patients included in SEAS, 1849 (99%) with mild to moderate AS (jet velocity 2.5–4.0 m/s at baseline) and available clinical, echocardiographic and follow-up data were analysed. Patients undergoing aortic valve replacement were censored at the time of operation.

Results During an overall follow-up of 46.1±14.6 months, SCD occurred in 27 asymptomatic patients (1.5%) after a mean of 28.3±16.6 months. The annualised event rate was 0.39%/year. The last follow-up echocardiography prior to the event showed mild to moderate stenosis in 22 and severe stenosis (jet velocity >4 m/s) in 5 victims of SCD. The annualised event rate after the diagnosis of severe stenosis was 0.60%/year compared with 0.46%/year in patients who did not progress to severe stenosis (p=0.79). Patients with SCD were older (p=0.01), had a higher left ventricular mass index (LVMI, p=0.001) and had a lower body mass index (BMI, p=0.02) compared with patients surviving follow-up. Cox regression analysis identified age (HR 1.06, 95% CI 1.01 to 1.11 per year, p=0.02), increased LVMI (HR 1.20, 95% CI 1.10 to 1.32 per 10 g/m2, p<0.001) and lower BMI (HR 0.87, 95% CI 0.79 to 0.97 per kg/m2, p=0.01) as independent risk factors of SCD.

Conclusion SCD in patients with asymptomatic mild to moderate AS is rare and strongly related to left ventricular hypertrophy but not stenosis severity.

  • aortic stenosis
  • cardiac arrest
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Footnotes

  • Contributors All authors designed the study. AR meticulously reviewed all available documents of patients having suffered from sudden death. JM and NJ categorised patients having died from sudden cardiac death or not according to any available information and performed the statistical analysis. JM wrote the manuscript with input and critical feedback from all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval This is a secondary analysis of the multicentre Simvastatin and Ezetimibe in Aortic Stenosis

    (SEAS) study (ClinicalTrials.gov number, NCT00092677). Study design and results of the SEAS study have been published previously. The study was approved by regional ethics committees in all participating countries, and all patients gave written informed consent.

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

  • Data availability statement Data are available upon reasonable request.

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