42.3% of patients with moderate AS underwent valve intervention within 5 years; mild AS patients had 44% higher risk of valve replacement vs non/trivial AS.
In the modern era, aortic stenosis is frequently identified at earlier stages, with a substantial proportion of patients presenting with mild or moderate disease eventually requiring valvular intervention over long-term follow-up.
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Abstract Introduction Aortic stenosis (AS) is amongs the most prevalent valvular heart diseases. Advances in diagnostic and therapeutic measures have significantly altered the disease course, making its natural history in the modern era distinct from the traditionally described. However, the trajectory of AS progression at present remains incompletely characterized. Purpose We aimed to characterize the presentation and progression of aortic stenosis in the modern era. Methods We conducted a single-center, retrospective cohort study at a tertiary medical center, analyzing consecutive patients undergoing sequential echocardiograms. Patients were stratified by AS severity at presentation (i.e., mild, moderate, or severe), and the cohort was assessed for disease progression and subsequent valvular interventions. Results A total of 395,000 echocardiograms of 62,091 individuals were screened. The median age at presentation was 61 (IQR 47-72) years and 52% male. Of these patients, 1,951, 1,155, and 1,220 had mild, moderate, and severe AS at baseline, respectively. Median follow-up time was 10.8 (IQR, 4.82 -16.99) years, during which 1,821 (42.1%) patients initially presented with AS underwent valvular intervention. Nine hundred ninety-four patients (54.6%) underwent surgical aortic valve replacement; the rest underwent transfemoral aortic valve replacement. Notably, 54% of these patients had non-severe AS at the outset. At 5-year follow-up, 42.3% of patients with moderate AS at presentation had undergone intervention, and even patients with mild AS exhibited a statistically significant increase in risk of progression to valve replacement compared with those with non/trivial AS (hazard ratio, 1.44; 95% CI, 1.30–1.60; p0.001). Conclusions In the modern era, AS is frequently identified at earlier stages. This results in prolonged follow-ups and a substantial proportion of interventions performed in patients with mild or moderate disease at presentation. These findings underscore the importance of structured periodic surveillance and timely intervention in this population. Figure 1 - Rates of valvular intervention by severity of aortic stenosis disease at presentationFigure 1 -Rates of valvular intervention
Ohad et al. (Sat,) reported a other. 42.3% of patients with moderate AS underwent valve intervention within 5 years; mild AS patients had 44% higher risk of valve replacement vs non/trivial AS.