Background and Aims 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. Methods All adults residents in Olmsted County (MN, USA) diagnosed over 20 years (1997–2016) with incident severe AS (first diagnosis) based on quantitatively defined measures (aortic valve area ≤ 1 cm2, aortic valve area index ≤ 0.6 cm2/m2, mean gradient ≥ 40 mmHg, peak velocity ≥ 4 m/s, Doppler velocity index ≤ 0.25) were counted to define trends in incidence, presentation, treatment, and outcome. Results Incident severe AS was diagnosed in 1069 community residents. The incidence rate was 52.5 [49.4–55.8] 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 [50.6–57.0] 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 [0.1–3.3] years in 1997–2000 to 0.5 [0.2–2.1] years in 2013–16, P = .001) but undertreatment remained prominent (>40%). Early AVR was associated with survival benefit (adjusted hazard ratio 0.55 [0.42–0.71], P < .0001). Despite these improvements, overall mortality (3-month 8% and 3-year 36%), was swift, considerable and unabated (all P ≥ .4) throughout the study. Conclusions 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.

中文翻译：

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严重主动脉瓣狭窄：发病率和结果的长期趋势

背景和目标 严重主动脉瓣狭窄 (AS) 是基于指南的主动脉瓣置换术 (AVR) 指征，随着经导管方法的出现，严重主动脉瓣狭窄 (AS) 显着增加，表明 AS 发生率可能会增加。然而，报道的 AS 发病率长期趋势仍然相互矛盾，并且缺乏定量多普勒超声心动图确定。方法 奥姆斯特德县（美国明尼苏达州）所有成年居民在 20 年（1997-2016 年）内被诊断患有严重 AS 事件（首次诊断），基于定量定义的测量（主动脉瓣面积 ≤ 1 cm2，主动脉瓣面积指数 ≤ 0.6 cm2/ m2、平均梯度 ≥ 40 mmHg、峰值速度 ≥ 4 m/s、多普勒速度指数 ≤ 0.25）进行计数，以确定发病率、表现、治疗和结果的趋势。结果 1069名社区居民确诊为重度AS。发病率为每 10 万名患者年 52.5 [49.4–55.8]，男性略高于女性，并且在美国人口年龄和性别调整后几乎没有变化，为每 10 万名居民每年 53.8 [50.6–57.0]。20 多年来，严重 AS 发病率保持稳定 (P = .2)，但由于人口增长，事件病例的绝对负担显着增加 (P = .0004)。发病率趋势因性别而异，男性稳定（发病率比 0.99，P = .7），但女性下降（发病率比 0.93，P = .02）。在整个研究中，AS 临床特征保持非常稳定，AVR 表现有所增长且更加迅速（从 1997-2000 年的 1.3 [0.1-3.3] 年到 2013-16 年的 0.5 [0.2-2.1] 年，P = .001），但治疗不足仍然很突出(>40%)。早期 AVR 与生存获益相关（调整后的风险比 0.55 [0.42–0.71]，P < .0001）。尽管有这些改善，但在整个研究过程中，总体死亡率（3 个月 8% 和 3 年 36%）迅速、显着且有增无减（所有 P ≥ .4）。结论 20 年来，严重 AS 的人口发病率保持稳定，但绝对病例负担随着人口增长而增加。尽管严重 AS 表现稳定，但 AVR 表现显着增长，但在下降的同时，治疗不足的情况仍然严重，疾病致死率尚未下降。这些基于人群的发现对于改善 AS 管理途径具有重要意义。