Abstract 14073: Deterioration of Functional Status and Timing of Intervention in Patients With Aortic Stenosis: Results From the PROGRESSA Study

Abstract

Introduction: The assessment of changes in functional status during follow-up is critical to determine the timing of intervention in patients with aortic stenosis (AS). Fast progression of AS (annualized progression of peak jet velocity [V peak ] ≥30 cm/s) is among the risk markers recommended in the guidelines to trigger early intervention in asymptomatic severe AS. We investigated the association between the progression of AS hemodynamic severity and the change in functional status during follow-up of patients with asymptomatic mild to moderate AS. Methods: 285 patients with AS prospectively recruited in the PROGRESSA study (NCT01679431) were included in this analysis. Functional status was evaluated using the New York Heart Association (NYHA) classification. Results: Baseline NYHA class was similar (class I, II, III: 57%, 41%, 2% versus 58%, 41%, 1%; p=0.75) between patients with moderate (V peak progression ≥12 cm/s/year; median of cohort) versus those with slow AS progression rate. During a mean follow-up of 3.9±2.4 years, patients with moderate AS progression rate had larger increase in NYHA class compared to those with slow progression (+0.13±0.48 versus +0.01±0.21 class/year; p=0.008). From baseline to 2 years, a significant worsening of NYHA class occurred but only in the moderate AS progression group ( Figure ). In multivariable analysis, AS progression rate remained significantly associated with the change in NYHA class (p=0.04).A total of 156 clinical events (110 AVR and 46 deaths) occurred during a mean follow-up of 1.1±1.5 years after the last echocardiographic visit. Patients with ≥1 class increase in NYHA (n=70) had significantly higher risk of events (adjusted hazard ratio: 1.75 [95% CI: 1.12-2.75]; p=0.01). Conclusions: In this prospective cohort of patients with mild to moderate AS at baseline, the decline in functional status occurs early in the course of the disease and is in large part determined by the progression rate of AS hemodynamic severity.