08 May

The Natural History and Rate of Progression of Aortic Stenosis: Results

The Natural History and Rate of Progression of Aortic Stenosis: ResultsPeter et al prospectively followed up 49 adults with aortic stenosis. At entry, the average peak instantaneous gradient was 38±15 mm Hg (range, 16 to 78 mm Hg). Patients were followed up for a mean duration of 32 months. The peak transaortic pressure gradient changed by +16 to +93 mm Hg, corresponding to a mean increase of 10.6±11 mm Hg/yr. Of the 49 patients, 21 were identified as “rapid progressors” as defined by a ^10 mm Hg/yr increase in the peak gradient. These patients were older (64 vs 53 years, p<0.01) and coronary artery disease was more prevalent (38% vs 7%, p=0.01). The rate of progression was not found to correlate with either age or the extent of coronary artery disease when evaluated in other studies.
When 123 adults were followed up prospectively for a mean duration of 2.5±1.4 years, once again, marked individual variability in the rate of hemodynamic progression was seen. The Doppler-derived mean gradient increased by 7±7 mm Hg/yr (—5 to 31 mm Hg) and the valve area decreased by 0.12±0.19 cm2/yr (—0.35 to 1.16). Clinical factors to predict the rate of hemodynamic progression were not found. However, the echocardiographic severity of aortic stenosis at baseline along with the rate of change over time were predictors of clinical outcome—death or need for valve surgery.

Overall, with respect to the rate of progression of acquired valvular aortic stenosis, on average, the aortic valve area decreases by approximately 0.1 cm2/yr and the peak instantaneous gradient increases by 10 mm Hg/yr. However, in any individual patient, at best we can say that that it is highly variable. There can be identified two distinct types of patients: those whose conditions progress slowly and others whose conditions progress rapidly. Unfortunately, unless privy to knowledge of prior hemodynamic data, there are no reliable clinical predictors to help us identify into which subgroup an individual patient will fall.

Categories: Aortic Stenosis
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