Tools
Tools
Tsampasian, Vasiliki, Grafton-Clarke, Ciaran 
ORCID: https://orcid.org/0000-0002-8537-0806, Gracia Ramos, Abraham Edgar, Asimakopoulos, George, Garg, Pankaj ORCID: https://orcid.org/0000-0002-5483-169X, Prasad, Sanjay, Ring, Liam, McCann, Gerry P., Rudd, James, Dweck, Marc R. and Vassiliou, Vassilios S. ORCID: https://orcid.org/0000-0002-4005-7752
(2022)
Management of asymptomatic severe aortic stenosis: A systematic review and meta-analysis.
Open Heart, 9 (1).
ISSN 2053-3624
Preview |
PDF (e001982.full)
- Published Version
Available under License Creative Commons Attribution. Download (1MB) | Preview |
Abstract
Objectives: The management of severe aortic stenosis mandates consideration of aortic valve intervention for symptomatic patients. However, for asymptomatic patients with severe aortic stenosis, recent randomised trials supported earlier intervention. We conducted a systematic review and meta-analysis to evaluate all the available data comparing the two management strategies. Methods: PubMed, Cochrane and Web of Science databases were systematically searched from inception until 10 January 2022. The search key terms were ‘asymptomatic’, ‘severe aortic stenosis’ and ‘intervention’. Results: Meta-analysis of two published randomised trials, AVATAR and RECOVERY, included 302 patients and showed that early intervention resulted in 55% reduction in all-cause mortality (HR=0.45, 95% CI 0.24 to 0.86; I2 0%) and 79% reduction in risk of hospitalisation for heart failure (HR=0.21, 95% CI 0.05 to 0.96; I2 15%). There was no difference in risk of cardiovascular death between the two groups (HR=0.36, 95% CI 0.03 to 3.78; I2 78%). Additionally, meta-analysis of eight observational studies showed improved mortality in patients treated with early intervention (HR=0.38, 95% CI 0.26 to 0.56; I2 77%). Conclusion: This meta-analysis provides evidence that, in patients with severe asymptomatic aortic stenosis, early intervention reduces all-cause mortality and improves outcomes compared with conservative management. While this is very encouraging, further randomised controlled studies are needed to draw firm conclusions and identify the optimal timing of intervention.
| Item Type: | Article |
|---|---|
| Additional Information: | Funding Information: Funding This work was partly funded by Wellcome Trust grants (220703/Z/20/Z). VT and CG-C are NIHR Academic Clinical Fellows. JR is part-supported by the NIHR Cambridge Biomedical Research Centre, the British Heart Foundation, HEFCE, the EPSRC and the Wellcome Trust. MRD is supported by the British Heart Foundation (FS/14/78/31020) and is the recipient of a Sir Jules Thorn Award for Biomedical Research 2015 (15/JTA). |
| Uncontrolled Keywords: | cardiology and cardiovascular medicine ,/dk/atira/pure/subjectarea/asjc/2700/2705 |
| Faculty \ School: | Faculty of Medicine and Health Sciences > Norwich Medical School |
| UEA Research Groups: | Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health |
| Related URLs: | |
| Depositing User: | LivePure Connector |
| Date Deposited: | 25 May 2022 16:32 |
| Last Modified: | 19 Oct 2023 03:20 |
| URI: | https://ueaeprints.uea.ac.uk/id/eprint/85165 |
| DOI: | 10.1136/openhrt-2022-001982 |
Downloads
Downloads per month over past year
Actions (login required)
 |
View Item |