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Incident aortic stenosis in 49 449 men and 42 229 women investigated with routine echocardiography
  1. Simon Stewart1,2,
  2. Yih-Kai Chan3,
  3. David Playford4,
  4. Geoffrey A Strange4,5,6,7
  5. NEDA Investigators
  1. 1Centre for Cardiopulmonary Health, Torrens University Australia, Adelaide, South Australia, Australia
  2. 2School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
  3. 3Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
  4. 4School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia
  5. 5Clinical Research Group, Heart Research Institute, Sydney, New South Wales, Australia
  6. 6Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
  7. 7Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Professor Geoffrey A Strange, School of Medicine, University of Notre Dame Australia, Fremantle, Western Australia, Australia; gstrange{at}neda.net.au

Abstract

Objective We addressed the paucity of data describing the characteristics and consequences of incident aortic stenosis (AS).

Methods Adults undergoing echocardiography with a native aortic valve (AV) and no AS were studied. Subsequent age-specific and sex-specific incidence of AS were derived from echocardiograms conducted a median of 2.8 years apart. Progressive AV dysfunction and individually linked mortality were examined per AS category.

Results 49 449 men (53.9%, 60.9±15.8 years) and 42 229 women (61.6±16.9 years) with no initial evidence of AS were identified. Subsequently, 6293 (6.9%) developed AS—comprising 5170 (5.6%), 636 (0.7%), 339 (0.4%) and 148 (0.2%) cases of mild, moderate, severe low-gradient and severe high-gradient AS, respectively. Age-adjusted incidence rates of all grades of AS were 17.5 cases per 1000 men/annum and 18.7 cases per 1000 women/annum: rising from ~5 to ~40 cases per 1000/annum in those aged <30 years vs >80 years. Median peak AV velocity increased by +0.57 (+0.36 to +0.80) m/s in mild AS compared with +2.75 (+2.40 to +3.19) m/s in severe high-gradient AS cases between first and last echocardiograms. During subsequent median 7.7 years follow-up, 24 577 of 91 678 cases (26.8%) died. Compared with no AS, the adjusted risk of all-cause mortality was 1.42-fold higher in mild AS, 1.92-fold higher in moderate AS, 1.95-fold higher in severe low-gradient AS and 2.27-fold higher in severe, high-gradient AS cases (all p<0.001).

Conclusions New onset AS is a common finding among older patients followed up with echocardiography. Any grade of AS is associated with higher mortality, reinforcing the need for proactive vigilance.

  • aortic stenosis

Data availability statement

Data are available upon reasonable request. The NEDA collaboration encourages use of the NEDA data with the cooperation of participating sites and responsible NEDA investigators—a full list of which is available (with contact details for advice on accessing data) via NEDA’s home website (https://www.neda.net.au/).

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Data availability statement

Data are available upon reasonable request. The NEDA collaboration encourages use of the NEDA data with the cooperation of participating sites and responsible NEDA investigators—a full list of which is available (with contact details for advice on accessing data) via NEDA’s home website (https://www.neda.net.au/).

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Footnotes

  • Twitter @PlayfordDavid

  • Contributors GAS and DP conceived and designed the National Echo Database of Australia Study. SS conceived this analysis and conducted study analyses with Y-KC, and all authors contributed to the interpretation of study data. SS wrote the manuscript and all authors contributed to its revision. GAS and DP are the guarantors of the overall veracity and accuracy of NEDA data presented in this manuscript.

  • Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. However, NEDA has received investigator-initiated funding support from Janssen and Novartis Pharmaceuticals and Edward Lifesciences in the past 3 years. SS is currently supported by the NHMRC of Australia (GNT1135894).

  • Competing interests GAS and DP are the co-principal investigators and directors of NEDA (a not-for-profit research entity). SS and Y-KC have received consultancy fees from NEDA. SS, DP and GAS have previously received consultancy/speaking fees from Edwards Lifesciences.

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

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

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