Some symptoms persisted in more than half of patients.

Symptoms such as angina, heart failure or syncope are generally indications for valve replacement in patients with severe aortic stenosis (AS), but do those symptoms always resolve after valve replacement? In this retrospective study from Spain, investigators studied 451 consecutive patients with symptomatic severe AS (but no other clinically important valve or coronary disease) who survived valve replacement; 58% underwent surgery and 42% underwent transcatheter replacement. Almost 30% of patients had been hospitalised for heart failure (HF) prior to valve replacement. Of the remaining patients, more than 90% had dyspnoea on effort, 40% had angina and 19% had syncope.

Symptoms resolved after valve replacement in 192 patients (43%), but some symptoms persisted in the remaining patients, including 193 with dyspnoea, 60 with hospitalisation for HF, 17 with syncope and nine with angina. Older age, higher body mass index, prior admissions for HF, and chronic obstructive pulmonary disease (COPD) were all associated independently with persistent symptoms. During median follow up of 56 months, 129 patients died. Persistence of symptoms was associated independently with mortality (hazard ratio, 2.08).

Comment: This retrospective study suggests some degree of symptom persistence is common after valve replacement for severe AS, which is unsurprising when concomitant conditions like COPD, HF and obesity coexist. Symptom persistence was also associated with mortality, suggesting it helps define those with poorer prognoses after intervention. Nevertheless, given the poor outcomes associated with medical therapy for severe AS, symptomatic severe AS remains a strong indication for valve replacement, even if concomitant disease is present.

Kirsten E. Fleischmann, MD, MPH, FACC, Professor of Clinical Medicine and Assistant Chair of Medicine, Faculty Experience, University of California San Francisco School of Medicine, San Francisco, USA.

San Román JA, et al. Evolution and prognostic significance of patient­ reported symptoms after intervention in severe aortic stenosis. Mayo Clin Proc 2024; 99: 400-­410.

This summary is taken from the following Journal Watch titles: General Medicine, Cardiology, Ambulatory Medicine, Hospital Medicine.