Factors leading to progression of valvular aortic stenosis

The rate of progression of aortic stenosis [AS) in adults is variable. To d etermine whether clinical or echocardiographic variables are associated wit h more rapid hemodynamic progression, we identified 91 AS patients (initial valve area less than or equal to 2.0 cm(2)) with 2 technically adequate st udies separated by greater than or equal to 6 months. From the first study, left ventricular dimensions and AS severity were measured by standard Dopp ler-echocardiographic methods. Each aortic valve was graded for severity of calcification and degree of restricted leaflet motion; the sum of these gr ades provided a severity index reflecting leaflet pathology. Clinical and e lectrocardiographic variables were abstracted from medical records. Mean ag e was 68 years (range 29 to 89) and 61 were women. initial AS severity rang ed from an aortic valve area of 0.6 to 2.0 cm(2) (median 1.3 cm(2)). During a mean follow-vp of 1.8 years the aortic valve area decreased 0.04 cm(2)/y ear. The patient group with mere rapid progression (decrease in aortic valv e area greater than or equal to 0.1 cm(2)/year) had a larger proportion of men (p <0.01) and patients with an elevated serum creatinine (p = 0.04), a higher left ventricular mass index (p = 0.01), and a higher severity index (p <0.001). Multivariable regression analysis identified the severity index (direct relation) and the initial aortic valve area (inverse relation) as the only independent variables associated with more rapid progression. In c onclusion, the rate of AS progression, although highly variable, is more ra pid when leaflet calcification is more marked. (C) 1999 by Excerpta Medica, Inc.