Management of asymptomatic severe aortic stenosis: A systematic review and meta-analysis

Tsampasian, Vasiliki, Grafton-Clarke, Ciaran ORCID:, Gracia Ramos, Abraham Edgar, Asimakopoulos, George, Garg, Pankaj ORCID:, Prasad, Sanjay, Ring, Liam, McCann, Gerry P., Rudd, James, Dweck, Marc R. and Vassiliou, Vassilios S. ORCID: (2022) Management of asymptomatic severe aortic stenosis: A systematic review and meta-analysis. Open Heart, 9 (1). ISSN 2053-3624

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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
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Depositing User: LivePure Connector
Date Deposited: 25 May 2022 16:32
Last Modified: 19 May 2023 09:38
DOI: 10.1136/openhrt-2022-001982

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