PROGRESSION OF AORTIC-STENOSIS - ROLE OF AGE AND CONCOMITANT CORONARY-ARTERY DISEASE

To determine the spontaneous progression of valvular aortic stenosis a nd to delineate clinical factors related to progression, a longitudina l study, including 49 patients (aged 16 to 81 years), was performed. A ll patients had auscultatory findings of aortic stenosis and multiple Doppler echocardiograms separated by at least 11 months. Rapid progres sion of aortic stenosis was defined as an increase of maximal instanta neous pressure gradient by greater-than-or-equal-to 10 mm Hg per year. During a mean follow-up period of 32 months (11 to 66 months), maxima l pressure gradient rose from 38 +/- 15 to 60 +/- 20 mm Hg in the enti re study population, resulting in a median increase of 7.2 mm Hg per y ear. In 21 patients (43 percent), an increase of greater-than-or-equal -to 10 mm Hg per year was found; in this subgroup with rapid progressi on, patients were older (64 vs 53 years, p < 0.01) and coronary artery disease was more prevalent (38 percent vs 7 percent, p = 0.01). We co nclude that nearly half the patients with initially mild to moderate v alvular aortic stenosis reveal a progression of greater-than-or-equal- to 10 mm Hg per year.