Progression to severe aortic stenosis was associated with significantly higher all-cause mortality compared to non-progression (56.7% vs. 32.4%, p=0.023).
Cohort (n=101)
Degenerative etiology, change in mean pressure gradient, and stroke volume index are independent predictors of aortic stenosis progression in Asian patients, which is associated with significantly higher all-cause mortality.
Absolute Event Rate: 56.7% vs 32.4%
p-value: p=0.023
Abstract Background Aortic stenosis (AS) is the most prevalent valvulopathy globally. There remains a knowledge gap on clinical determinants of AS progression in Asian patients. Insights into this may confer prognostic benefits. Methods 101 patients with index diagnoses of aortic stenosis and paired echocardiograms 2 years apart were enrolled between 2011-2021. Patients were stratified into 2 groups - the first were AS progressors, defined by progression to severe AS: aortic valve area (AVA)1.0cm², mean pressure gradient (MPG)40mmHg, peak jet velocity (Vmax)4 m/s, from moderate AS: AVA 1.0-1.5cm², Vmax 3-4m/s, MPG 20-40mmHg. The second group was AS non-progressors who did not meet progression criteria. Demographics, co-morbidities, echocardiographic parameters and clinical outcomes were compared. Results AS progression was associated with higher proportions of smoking, hypertension, hyperlipidaemia, diabetes and coronary artery disease. The mean rate of AVA change/year was 0.7+0.8cm² in progressors vs. 0.1+0.3cm² in non-progressors (p0.001), the mean rate of MPG change/year was 7.4+17.5mmHg vs. 1.9+10.5mmHg (p0.001), and the mean rate of Vmax change/year was 0.5+1.0m/s vs. 0.1+0.6m/s (p=0.004). Degenerative aetiology (OR 3.57, p=0.005), change in MPG (OR 1.08, p=0.002) and stroke volume index (SVi) (OR 0.95, p=0.01) were independent predictors of AS progression. AS progressors had higher all-cause mortality compared to AS non-progressors (56.7% vs. 32.4%, p=0.023). The concomitant presence of chronic kidney disease grade 3 and above was associated with worse all-cause mortality in this subset (HR 4.29, p0.001). More AS progressors were on aspirin (63.3% vs. 40.8%, p=0.039) and mineralocorticoid receptor antagonists (10.0% vs. 0%, p=0.024). More AS progressors underwent aortic valve intervention (26.7% vs. 8.5%, p=0.025) and had a shorter duration to follow-up (4.4+2.8 years vs. 5.8+2.9 years, p=0.030). Conclusion Degenerative AS, MPG and SVi were reliable predictors of AS progression in the Asian cohort, which had a significant impact on all-cause mortality.Characteristics by AS Progression Kaplan-Meier for All-Cause Mortality
Ong et al. (Thu,) conducted a cohort in Aortic stenosis (n=101). Progression to severe aortic stenosis vs. Non-progression of aortic stenosis was evaluated on All-cause mortality (p=0.023). Progression to severe aortic stenosis was associated with significantly higher all-cause mortality compared to non-progression (56.7% vs. 32.4%, p=0.023).