Mortality and morbidity of XXXX in clinical practice. A long-term follow-up study.

@entity1 @entity712 @entity337 @entity955
BACKGROUND: The outcome of @entity337 conservatively followed in clinical practice is poorly defined. METHODS AND RESULTS: Long-term outcome of 246 @entity1 with severe or moderately severe @entity337 diagnosed by color Doppler echocardiography was analyzed. With conservative management, mortality rate was higher than expected (at 10 years, 34+/-5%, P<0. 001) and morbidity was high (10-year rates of 47+/-6% for @entity712 and 62+/-4% for aortic valve surgery). At 10 years, 75+/-3% of @entity1 had died or had surgery and 83+/-3% had had cardiovascular events. In multivariate analysis, predictors of survival were age (P<0.001), functional class (P<0.001), comorbidity index (P=0.033), @entity955 (P=0.002), and left ventricular end-systolic diameter corrected for body surface area (P=0.025). Ejection fraction was also an independent predictor of overall survival, including postoperative follow-up of surgically treated @entity1 (P<0.001). High risk during conservative treatment, with mortality rate in excess of that expected, was noted among @entity1 with severe, even transient, symptoms (24.6% yearly, P<0.001) but also in those with mild (class II) symptoms (6.3% yearly, P=0.02) and in asymptomatic @entity1 with left ventricular ejection fraction <55% (5.8% yearly, P=0.03) or with end-systolic diameter normalized to body surface area >/=25 mm/m2 (7.8% yearly, P=0.004). Surgery performed during follow-up was independently associated with reduced cardiovascular mortality (adjusted hazard ratio, 0.54; P=0.048). CONCLUSIONS: @entity1 diagnosed with severe @entity337 in clinical practice incur excess mortality and high morbidity, underscoring the serious prognosis of the disease. Surgery, which reduces cardiac mortality rates, should be considered promptly in high-risk @entity1 .
