Aortic stenosis is an increasingly common valvulopathy because people are living longer now. A present, the main treatment consists of surgical (SAVR) or transcatheter aortic valve replacement. (TAVR).
One of the main challenges of this disease is its progression. The European guidelines recommend Doppler echocardiograms every 2 to 3 years for mild cases, mildly calcified, annually for moderate cases and every 6 months in severe cases, to assess treatment need. On the other hand, the US guidelines are less strict, recommending echocardiograms every 3 to 5 years in mild cases, 1 or 2 years in moderate cases and every 6 to 12 months for severe cases.
This was a study on 540 patients with aortic stenosis presenting aortic valve area >1 cm2 and ≤1.5 cm2, mean gradient ≥20 mmHg and ≤40 mmHg, and peak jet velocity ≥3 m/s and <4 m/s.
They had a baseline echocardiogram and another one at 6 months. It was observed that 270 patients presented slow progression with annual valve area increase of 0,04 cm2, while the rest showed rapid progression with 0,15 cm2 annual increase.
Read also: Quality of Life in Medium-Risk Patients Treated with TAVR vs SAVR.
Rapid progression patients tended to be older (69 vs. 65 years, p>0.001) and present bicuspid valves, atrial fibrillation, and kidney failure deterioration, with no significant differences in other comorbidities.
Also, they initially showed larger aortic valve area (1,4 cm2 vs. 1,3 cm2, p<0,001) with no difference in gradient, or presence of aortic valve failure, mitral or tricuspid. Left ventricular mass index was greater in patients presenting rapid progression
Over the followup period, there was a reduction of 0,09 cm2 in aortic valve area, 0,17 m/s peak velocity and 3,1 mmHg mean pressure gradient per year.
Read also: TAVR in Bicuspid Valves.
After a 10 year followup, it was found patients with rapid progression had higher rates of valve replacement (SAVR or TAVR) (54,8% vs. 41,1%, p=0,002), as well as higher mortality (40,7% vs. 25,6%, p<0,001) and hospitalization for cardiac failure (20,9% vs. 1,08%, p=0,002), with no significant differences in atrial fibrillation, MI, pacemaker implantation, PCI, CABG, stroke or peripheral artery disease.
Rapid progression predictors were advanced age, atrial fibrillation, left ventricular mass index and kidney function deterioration.
Conclusion
Aortic valve area linear reduction in individual patients has shown that rapid progression of aortic stenosis was independently associated with higher mortality. Clinical and echocardiographic followup might predict this progression and help determine optimal management of aortic stenosis patients
Dr. Carlos Fava.
Member of the Editorial Board of SOLACI.org.
Original Title: Prediction of the Individual Aortic Stenosis Progression Rate and its Association With Clinical Outcomes.
Reference: Constantijn S. Venema, et al. JACC Adv 2024;3:100879.
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