{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:39:28Z","timestamp":1791297568963,"version":"4.1.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2010,1,5]]},"abstract":"<jats:p>\n                    <jats:bold>\n                      <jats:italic>Background\u2014<\/jats:italic>\n                    <\/jats:bold>\n                    We sought to assess the outcome of asymptomatic patients with very severe aortic stenosis.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>\n                      <jats:italic>Methods and Results\u2014<\/jats:italic>\n                    <\/jats:bold>\n                    We prospectively followed 116 consecutive asymptomatic patients (57 women; age, 67\u00b116 years) with very severe isolated aortic stenosis defined by a peak aortic jet velocity (AV-Vel) \u22655.0 m\/s (average AV-Vel, 5.37\u00b10.35 m\/s; valve area, 0.63\u00b10.12 cm\n                    <jats:sup>2<\/jats:sup>\n                    ). During a median follow-up of 41 months (interquartile range, 26 to 63 months), 96 events occurred (indication for aortic valve replacement, 90; cardiac deaths, 6). Event-free survival was 64%, 36%, 25%, 12%, and 3% at 1, 2, 3, 4, and 6 years, respectively. AV-Vel but not aortic valve area was shown to independently affect event-free survival. Patients with an AV-Vel \u22655.5 m\/s had an event-free survival of 44%, 25%, 11%, and 4% at 1, 2, 3, and 4 years, respectively, compared with 76%, 43%, 33%, and 17% for patients with an AV-Vel between 5.0 and 5.5 m\/s (\n                    <jats:italic>P<\/jats:italic>\n                    &lt;0.0001). Six cardiac deaths occurred in previously asymptomatic patients (sudden death, 1; congestive heart failure, 4; myocardial infarction, 1). Patients with an initial AV-Vel \u22655.5 m\/s had a higher likelihood (52%) of severe symptom onset (New York Heart Association or Canadian Cardiovascular Society class &gt;II) than those with an AV-Vel between 5.0 and 5.5 m\/s (27%;\n                    <jats:italic>P<\/jats:italic>\n                    =0.03).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>\n                      <jats:italic>Conclusions\u2014<\/jats:italic>\n                    <\/jats:bold>\n                    Despite being asymptomatic, patients with very severe aortic stenosis have a poor prognosis with a high event rate and a risk of rapid functional deterioration. Early elective valve replacement surgery should therefore be considered in these patients.\n                  <\/jats:p>","DOI":"10.1161\/circulationaha.109.894170","type":"journal-article","created":{"date-parts":[[2009,12,21]],"date-time":"2009-12-21T21:37:14Z","timestamp":1261431434000},"page":"151-156","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":445,"title":["Natural History of Very Severe Aortic Stenosis"],"prefix":"10.1161","volume":"121","author":[{"given":"Raphael","family":"Rosenhek","sequence":"first","affiliation":[{"name":"From the Department of Cardiology (R.R., R.Z., G.M., S.G., J.B.-K., H.G., G.M.), Department of Medical Statistics and Informatics, Section of Clinical Biometrics (M.S.), and Department of Cardiac Surgery (M.C., M.G.), Medical University of Vienna, Vienna, Austria."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Zilberszac","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology (R.R., R.Z., G.M., S.G., J.B.-K., H.G., G.M.), Department of Medical Statistics and Informatics, Section of Clinical Biometrics (M.S.), and Department of Cardiac Surgery (M.C., M.G.), Medical University of Vienna, Vienna, Austria."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Schemper","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology (R.R., R.Z., G.M., S.G., J.B.-K., H.G., G.M.), Department of Medical Statistics and Informatics, Section of Clinical Biometrics (M.S.), and Department of Cardiac Surgery (M.C., M.G.), Medical University of Vienna, Vienna, Austria."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Czerny","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology (R.R., R.Z., G.M., S.G., J.B.-K., H.G., G.M.), Department of Medical Statistics and Informatics, Section of Clinical Biometrics (M.S.), and Department of Cardiac Surgery (M.C., M.G.), Medical University of Vienna, Vienna, Austria."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Mundigler","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology (R.R., R.Z., G.M., S.G., J.B.-K., H.G., G.M.), Department of Medical Statistics and Informatics, Section of Clinical Biometrics (M.S.), and Department of Cardiac Surgery (M.C., M.G.), Medical University of Vienna, Vienna, Austria."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Senta","family":"Graf","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology (R.R., R.Z., G.M., S.G., J.B.-K., H.G., G.M.), Department of Medical Statistics and Informatics, Section of Clinical Biometrics (M.S.), and Department of Cardiac Surgery (M.C., M.G.), Medical University of Vienna, Vienna, Austria."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jutta","family":"Bergler-Klein","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology (R.R., R.Z., G.M., S.G., J.B.-K., H.G., G.M.), Department of Medical Statistics and Informatics, Section of Clinical Biometrics (M.S.), and Department of Cardiac Surgery (M.C., M.G.), Medical University of Vienna, Vienna, Austria."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Grimm","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology (R.R., R.Z., G.M., S.G., J.B.-K., H.G., G.M.), Department of Medical Statistics and Informatics, Section of Clinical Biometrics (M.S.), and Department of Cardiac Surgery (M.C., M.G.), Medical University of Vienna, Vienna, Austria."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald","family":"Gabriel","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology (R.R., R.Z., G.M., S.G., J.B.-K., H.G., G.M.), Department of Medical Statistics and Informatics, Section of Clinical Biometrics (M.S.), and Department of Cardiac Surgery (M.C., M.G.), Medical University of Vienna, Vienna, Austria."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Maurer","sequence":"additional","affiliation":[{"name":"From the Department of Cardiology (R.R., R.Z., G.M., S.G., J.B.-K., H.G., G.M.), Department of Medical Statistics and Informatics, Section of Clinical Biometrics (M.S.), and Department of Cardiac Surgery (M.C., M.G.), Medical University of Vienna, Vienna, Austria."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/9.suppl_E.57"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.38.1S5.V-61"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.35.1.41"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.95.9.2262"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200008313430903"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.02.056"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehm095"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1053\/euhj.2002.3163"},{"key":"e_1_3_2_9_2","unstructured":"Society of Thoracic Surgeons. 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