{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T20:18:51Z","timestamp":1793132331204,"version":"4.5.0"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"21","license":[{"start":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T00:00:00Z","timestamp":1704672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Severe aortic stenosis (AS) is the guideline-based indication for aortic valve replacement (AVR), which has markedly increased with transcatheter approaches, suggesting possible increasing AS incidence. However, reported secular trends of AS incidence remain contradictory and lack quantitative Doppler echocardiographic ascertainment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All adults residents in Olmsted County (MN, USA) diagnosed over 20 years (1997\u20132016) with incident severe AS (first diagnosis) based on quantitatively defined measures (aortic valve area \u2264 1\u2005cm2, aortic valve area index \u2264 0.6\u2005cm2\/m2, mean gradient \u2265 40\u2005mmHg, peak velocity \u2265 4\u2005m\/s, Doppler velocity index \u2264 0.25) were counted to define trends in incidence, presentation, treatment, and outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Incident severe AS was diagnosed in 1069 community residents. The incidence rate was 52.5 [49.4\u201355.8] per 100 000 patient-year, slightly higher in males vs. females and was almost unchanged after age and sex adjustment for the US population 53.8 [50.6\u201357.0] per 100 000 residents\/year. Over 20 years, severe AS incidence remained stable (P = .2) but absolute burden of incident cases markedly increased (P = .0004) due to population growth. Incidence trend differed by sex, stable in men (incidence rate ratio 0.99, P = .7) but declining in women (incidence rate ratio 0.93, P = .02). Over the study, AS clinical characteristics remained remarkably stable and AVR performance grew and was more prompt (from 1.3 [0.1\u20133.3] years in 1997\u20132000 to 0.5 [0.2\u20132.1] years in 2013\u201316, P = .001) but undertreatment remained prominent (&amp;gt;40%). Early AVR was associated with survival benefit (adjusted hazard ratio 0.55 [0.42\u20130.71], P &amp;lt; .0001). Despite these improvements, overall mortality (3-month 8% and 3-year 36%), was swift, considerable and unabated (all P \u2265 .4) throughout the study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Over 20 years, the population incidence of severe AS remained stable with increased absolute case burden related to population growth. Despite stable severe AS presentation, AVR performance grew notably, but while declining, undertreatment remained substantial and disease lethality did not yet decline. These population-based findings have important implications for improving AS management pathways.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurheartj\/ehad887","type":"journal-article","created":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T19:58:27Z","timestamp":1703275107000},"page":"1877-1886","source":"Crossref","is-referenced-by-count":68,"title":["Severe aortic stenosis: secular trends of incidence and outcomes"],"prefix":"10.1093","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5660-6162","authenticated-orcid":false,"given":"Giovanni","family":"Benfari","sequence":"first","affiliation":[{"name":"Department ofCardiovascular Disease, Mayo Clinic , Rochester, MN , USA"},{"name":"Section of Cardiology, University of Verona , Verona , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7116-5529","authenticated-orcid":false,"given":"Benjamin","family":"Essayagh","sequence":"additional","affiliation":[{"name":"Department ofCardiovascular Disease, Mayo Clinic , Rochester, MN , USA"},{"name":"Department of Echocardiography, Cardio X Clinic , Cannes , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hector I","family":"Michelena","sequence":"additional","affiliation":[{"name":"Department ofCardiovascular Disease, Mayo Clinic , Rochester, MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zi","family":"Ye","sequence":"additional","affiliation":[{"name":"Department ofCardiovascular Disease, Mayo Clinic , Rochester, MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose Medina","family":"Inojosa","sequence":"additional","affiliation":[{"name":"Department ofCardiovascular Disease, Mayo Clinic , Rochester, MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio L","family":"Ribichini","sequence":"additional","affiliation":[{"name":"Section of Cardiology, University of Verona , Verona , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Crestanello","sequence":"additional","affiliation":[{"name":"Department ofCardiovascular Disease, Mayo Clinic , Rochester, MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6278-5670","authenticated-orcid":false,"given":"David","family":"Messika-Zeitoun","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Ottawa Heart Institute , Ottawa, Ontario , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6031-2124","authenticated-orcid":false,"given":"Bernard","family":"Prendergast","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cleveland Clinic and Saint Thomas\u2019 Hospitals , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin F","family":"Wong","sequence":"additional","affiliation":[{"name":"Olmsted Medical Center , Rochester, MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3304-2410","authenticated-orcid":false,"given":"Prabin","family":"Thapa","sequence":"additional","affiliation":[{"name":"Department ofCardiovascular Disease, Mayo Clinic , Rochester, MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0910-5450","authenticated-orcid":false,"given":"Maurice","family":"Enriquez-Sarano","sequence":"additional","affiliation":[{"name":"Minneapolis Heart Institute Foundation and the Valve Science Center , Minneapolis, MN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,1,8]]},"reference":[{"key":"2024060106515422900_ehad887-B1","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/S0140-6736(06)69208-8","article-title":"Burden of valvular heart diseases: a population-based study","volume":"368","author":"Nkomo","year":"2006","journal-title":"Lancet"},{"key":"2024060106515422900_ehad887-B2","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1161\/01.CIR.90.2.844","article-title":"Characterization of the early lesion of \u2018degenerative\u2019 valvular aortic stenosis. 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