From the Guidelines
The prognosis of aortic stenosis varies based on severity, but without treatment, severe aortic stenosis typically leads to death within 2-3 years after symptom onset, as stated in the 2016 study by 1.
Prognosis and Life Expectancy
The life expectancy of patients with aortic stenosis depends on the severity of the condition.
- Mild aortic stenosis generally has minimal impact on life expectancy.
- Moderate stenosis may progress over 2-5 years.
- Severe aortic stenosis, if left untreated, can lead to death within 2-3 years after symptom onset.
Symptoms and Survival Rates
Once symptoms develop, such as:
- Angina
- Syncope
- Heart failure survival rates decline significantly:
- Average survival is 5 years with angina
- 3 years with syncope
- Only 2 years with heart failure symptoms
Treatment and Outcomes
Aortic valve replacement (surgical or transcatheter) dramatically improves outcomes, with post-procedure life expectancy approaching normal for many patients, as supported by the 2017 guideline update by 1.
Monitoring and Follow-up
Regular monitoring is essential, with echocardiograms recommended:
- Every 6-12 months for severe stenosis
- 1-2 years for moderate stenosis
- 3-5 years for mild stenosis
Influencing Factors
Age, comorbidities, left ventricular function, and valve calcification also influence prognosis.
Medical Therapy
Medical therapy alone (including statins, ACE inhibitors, and careful blood pressure management) may slow progression but cannot reverse the mechanical obstruction of the valve, making valve replacement the definitive treatment for severe symptomatic aortic stenosis, as noted in the 2012 expert consensus document by 1.
From the Research
Prognosis of Aortic Stenosis
The prognosis of aortic stenosis (AS) varies depending on the severity of symptoms and treatment approach.
- Asymptomatic patients with severe AS have a relatively benign prognosis, but survival decreases rapidly after symptoms appear 2.
- Studies have shown that asymptomatic patients with severe AS who are advised against surgery have significantly higher mortality than patients who undergo aortic valve replacement 3, 4.
- The probability of death at 1 year after recommendation was 5.2% in the watchful waiting group and 4.7% in the aortic valve replacement group 3.
- Survival at 1,2, and 3 years for asymptomatic patients was 88%, 75%, and 63%, compared with 92%, 83%, and 78% in matched patients scheduled for aortic valve replacement 4.
Factors Affecting Prognosis
Several factors affect the prognosis of AS, including:
- Severity of symptoms: Severe symptoms such as angina, syncope, or heart failure are associated with higher mortality 5.
- Left ventricular ejection fraction (LVEF): Higher LVEF is associated with better survival 3, 6.
- Renal failure: Renal failure is associated with worse survival 3.
- Brain natriuretic peptide level: Lower brain natriuretic peptide level is associated with better survival 6.
- Global longitudinal strain (GLS): Higher GLS is associated with better survival 6.
Treatment Approach
The treatment approach for AS depends on the severity of symptoms and surgical risk.
- Aortic valve replacement is recommended for most symptomatic patients with evidence of significant AS on echocardiography 2.
- Watchful waiting is recommended for most asymptomatic patients, but select patients may benefit from aortic valve replacement before the onset of symptoms 2.
- Transcatheter aortic valve replacement may be considered in patients at high or prohibitive surgical risk 2.
- Balloon aortic valvuloplasty (BAV) is used in high-risk patients with severe AS when the benefit of transcatheter aortic valve replacement or surgical aortic valve replacement is unclear 6.