Rapid aortic stenosis progression occurred in 7.8% of patients with sclerosis, 16.4% with mild AS, and 29.8% with moderate AS, with predictors shifting from clinical to valve-related factors.
Clinical risk factors drive progression in early aortic valve disease, while echocardiographic severity drives progression in moderate aortic stenosis, suggesting tailored surveillance strategies may be beneficial.
Tasa de eventos absoluta: 0% vs 0%
Background Aortic stenosis (AS) is a progressive disease with substantial variability in its rate of progression. Current surveillance guidelines may not adequately identify individuals at highest risk for rapid haemodynamic deterioration. This study aims to assess AS progression rates and identify factors associated with rapid progression using real-world, longitudinal data. Methods Retrospective cohort study conducted within Kaiser Permanente Southern California, an integrated healthcare system. Adults aged ≥18 years with ≥2 transthoracic echocardiograms (TTEs) performed ≥180 days apart between 2011 and 2021 were included. Multivariable logistic regression was used to identify predictors of rapid progression, defined as an annualised increase in Vmax ≥0.3 m/s/year. The final cohort included 70 850 patients contributing 111 189 TTE pairs. Results Rapid progression occurred in 7.8% of patients with aortic sclerosis, 16.4% with mild AS and 29.8% with moderate AS. The mean annual increase in Vmax was 0.1 m/s/year; mean gradient increased by 1.6 mm Hg/year, and AVA declined by 0.1 cm²/year. Among patients with aortic sclerosis, rapid progression was significantly associated with older age, anaemia, liver disease, renal failure, pulmonary disease, peripheral vascular disease, cancer and obesity. In mild AS, anaemia and obesity remained significant, but echocardiographic parameters, including higher gradient and smaller AVA, were stronger predictors. In moderate AS, valve-related parameters predominated, and clinical characteristics were not significantly associated with progression. Conclusions and relevance AS progression varies by baseline severity and underlying risk profile. Incorporating clinical and echocardiographic risk factors into surveillance strategies may improve identification of patients most likely to benefit from closer monitoring or earlier intervention.
Lee et al. (Fri,) reported a other. Rapid aortic stenosis progression occurred in 7.8% of patients with sclerosis, 16.4% with mild AS, and 29.8% with moderate AS, with predictors shifting from clinical to valve-related factors.