Abstract 12686: Aortic Stenosis Progression in Patients With preserved Left Ventricular Ejection Fraction
Objective: Aortic stenosis (AS) affects 2-7% of the population> 65 years in the United States. Echocardiographic monitoring of disease progression is recommended every 1-2 years in moderate AS and every 3-5 years in mild AS. We explored the pattern, rate and clinical correlates of AS progression in patients with preserved LVEF upon initial diagnosis of AS
Methods: Patients presenting to Duke University Medical Center for echocardiography between Jan 1995 to Dec 2012 with at least mild AS, an LVEF≥50% and a follow-up examination at a minimum of 90 days later without intervening AVR were included. Patients were stratified by mean gradient into mild (≤25 mmHg), moderate (25-40 mmHg) or severe AS (>40 mmHg), Exclusion criteria were bicuspid aortic valve and severe aortic regurgitation
Results: A total of 1163 patients were included (median age 72 years, 48% male). The baseline severity of AS was mild in 806 (69%), moderate in 247 (21%) and severe in 110 (10%). During a median follow-up of 2.7 years (1.3-5.0) the mean gradient increased from 22 mmHg to 32 mmHg (p≤0.001) for an annualized rate of progression (ARP) of 3.5 mmHg/year (IQR: 0.3-5.6). Patients with rapid progression of AS defined as an ARP> 5.6 mmHg/year were characterized by a higher proportion of moderate AS at baseline and more pronounced AV thickening compared to those with slower or no progression (p≤0.001). Baseline clinical risk factors were not significantly different when comparing patients with rapid ARP versus those without. Among patients with mild AS at baseline and last follow-up within 5 years (n=546), 54 (10%) had developed severe AS. Among patients with moderate AS at baseline and last follow-up within 2 years (n=122), 65 (53%) had developed severe AS.
Conclusions: In this large contemporary cohort of medically managed patients with AS and preserved LVEF, progression of AS was not associated with any baseline clinical risk factors. A substantial number of patients with mild to moderate AS progress to severe within the currently guideline recommended time frame of follow-up.
- © 2013 by American Heart Association, Inc.