06 May

The Natural History and Rate of Progression of Aortic Stenosis: Valvular aortic stenosis

Otto et al prospectively followed up 42 adults with valvular aortic stenosis for a mean duration of 20 months. The average Doppler-derived peak systolic gradient was 54 mm Hg (range, 27 to 108 mm Hg). The peak transaortic pressure gradient changed by +12 mm Hg/yr ( — 10 to +34 mm Hg) and the mean gradient changed by +8 mm Hg/yr ( — 7 to +23 mm Hg). Data for the calculation of aortic valve area were available in 25 of the 42 patients, and revealed a mean reduction in aortic valve area of —0.1 cm2/yr (0.0 to —0.5 cm2). Those patients who subsequently required valve replacement as a result of progressive symptoms had a more rapid rate of hemodynamically determined deterioration. However, they were unable to identify variables to predict who these “fast progressors” would be.
Roger and colleagues reviewed 112 adult patients with aortic stenosis who underwent at least three echocardiographic evaluations during a mean 25-month period. At entry, the peak instantaneous gradient was 35 ± 18 mm Hg (6 to 100 mm Hg). After a mean interval of 25 months, the peak instantaneous gradient increased to 44 ±16 mm Hg, corresponding to an average increase of 4.8 mm Hg/yr. It was also recognized that those who progressed symptomatically had a significantly more rapid rate of hemodynamic progression. Again, no variables were identified that could predict the “fast progressors.”

A cohort of 45 adults with aortic stenosis was followed up by Faggiano and coworkers for a mean duration of 18 months. At entry, the peak instantaneous gradient varied from 25 to 174 mm Hg and valve area ranged between 0.35 and 1.6 cm2. The peak transaortic pressure gradient changed on average 15±10 mm Hg/yr (range, —8 to +38 mm Hg/yr). The change in calculated aortic valve area was, on average, —0.1±0.13 cm2/yr (range, —0.72 to +0.14 cm2/yr). Once again it should be noted that the rate of progression was variable among patients and that in general, no parameters could be identified to help differentiate “rapid” from “slow progressors.” One caveat to this was that those with a reduction in left ventricular systolic function had a faster rate of progression than did those with normal systolic function. This finding has not been consistently duplicated in other series.

Categories: Aortic Stenosis
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