The symptoms of aortic stenosis are ambiguous in the initial phase of the disease. The patient experiences a reduced exercise tolerance at the initial phase. At the late stage, dyspnea, angina, and syncope are experienced by the patients. The syncope develops when the heart is unable to sufficiently increase the stroke volume.

The author of this study wrote, “Decision making in severe aortic stenosis (AS) requires a comprehensive pre-operative evaluation of the risk-to-benefit ratio. The aim of this study was to assess whether certain pre-operative symptoms are associated with outcome after surgical aortic valve replacement (SAVR).”

This is a long-term observational study that involves a large contemporary cohort of patients. The study involves a total of 625 patients with isolated severe aortic stenosis. These patients are undergoing surgical aortic valve replacement.

The patients with syncope had significantly smaller left ventricular diameters, smaller aortic valve areas, right ventricular diameters, and right atrial diameters, left atrial diameters, and lower indexed stroke volumes compared with patients without syncope. The presence of syncope in these patients may increase mortality risk after SAVR with an adjusted hazard ratio of 2.27 and 2.11 for 1-year short-term mortality and 10-year long-term mortality respectively. There was no significant association found between angina, pre-operative dyspnea, and reduced left ventricular function with outcomes.

The study first time demonstrates that syncope may result in a poor prognosis after SAVR. Patients with syncope may experience lower stroke volumes, smaller aortic valve area, and smaller cardiac activities.


Goliasch G, Kammerlander AA, Nitsche C, Dona C, Schachner L, Öztürk B, Binder C, Duca F, Aschauer S, Laufer G, Hengstenberg C, Bonderman D, Mascherbauer J. Syncope: The Underestimated Threat in Severe Aortic Stenosis. JACC Cardiovasc Imaging. 2019 Fe