The aging of the US population has resulted in an increasing number of patients with calcific aortic stenosis encountered in clinical practice. As postulated by Ross and Braunwald 45 years ago,1 patients with aortic stenosis have a long latent phase with gradual increases in severity of valvular obstruction during which they remain asymptomatic. However, when the left ventricle can no longer compensate for the pressure overload, the onset of symptoms heralds an ominous prognosis if no intervention occurs. Although Ross and Braunwald focused on a younger population who developed symptoms in middle age, contemporary experience among elderly patients confirms the concept that the onset of symptoms identifies a crucial juncture in the natural history of aortic stenosis after which more than 50% of patients with medically managed severe aortic stenosis will die during the next 2 to 3 years.2
Bonow RO. Improving Outlook for Elderly Patients With Aortic Stenosis. JAMA. 2013;310(19):2045–2047. doi:10.1001/jama.2013.281825
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