Abstract 15636: Progression of Aortic Stenosis in Elderly Patients: Is There a Role for Measuring Aortic Valve Calcium Score?
Background: Prior studies with younger patients showed that a visual estimate of aortic valve calcification (AVC) is a determinant factor for hemodynamic progression to aortic stenosis (AS). However, an additive value of CT determination of AVC score is not well studied, especially in elderly patients (> 65 years). Current ACC/AHA guidelines recommending a repeat echocardiography in 2 years in moderate AS patients is also not well studied.
Methods: Thirty seven elderly patients were prospectively enrolled with various degrees of AS, ie, 1) mild AS, mean gradient (MG) 10-25 mmHg, n = 13; 2) moderate AS, MG 25-40 mmHg, n = 19; and 3) severe AS, MG > 40 mmHg, n = 5, and were compared to 16 age-matched control patients with no AS, all of whom underwent a CT scan to determine AVC score. All had a second echocardiographic study at 2.0 ± 0.8 years. Patients with subnormal EF or more than mild AR were excluded.
Results: Age (76 ± 6 yrs, 79 ± 5 yrs, 77 ± 6 yrs, 82 ± 11 yrs; p = 0.14), gender (p = 0.26), hypertension (p = 0.73), hyperlipidemia (p = 0.73) and CAD (p = 0.33) were not different between the groups (control, mild, moderate, and severe, respectively). Hemodynamic progression tended to be more rapid with worsening of the baseline AS severity (p < .0001, R2 = 0.40) (figure) and AVC score (p < .001, R2 = 0.20) in a univariate analysis. However, after adjusting for baseline variables including the baseline severity of AS, the AVC score was not predictive of AS progression. In addition, many patients (26%) with moderate AS had MG > 10 mmHg/yr of AS progression compared to none of the patients in the mild or control group.
Conclusion: Our study suggests that 1) In elderly patients the rate of AS progression depends on hemodynamic severity, which is related to underlying calcification. Further quantification of AVC score is of limited value, and 2) A substantial number of patients with moderate AS have rapid progression (MG > 10mmHg/yr) that may benefit from a closer follow-up than current ACC/AHA guidelines recommend.
- © 2013 by American Heart Association, Inc.