Abstract 17693: Metabolic and Hemodynamic Determinants of Progression of Mild to Moderate Aortic Stenosis in Patients With End Stage Renal Disease

Abstract

Background: We aimed to characterize progression of aortic stenosis (AS) with end stage renal disease (ESRD), and to determine metabolic and hemodynamic factors attributing to AS progression. Method:A total of 73 ESRD (50 males, age 72±11 years) on dialysis with mild (n=56) to moderate AS (n=17) were enrolled. Age, sex and AS severity matched control group with eGFR above 60 mL/min/1.73m2 was selected (n=79). Transthoracic echocardiography was performed at baseline and during follow up (48±23 months). Severity of AS was accessed by aortic valve area (AVA) calculated by continuity equations. Acceleration of AS was assessed by annual AVA reduction rate. Accelerated group in ESRD patients was defined as those with the highest quartile of AVA reduction rate. Clinical outcomes included aortic valve intervention, hospital admission due to heart failure, and death. Results: Annual AVA reduction rate was significantly higher in ESRD compared to control group (0.36±1.9 vs. 0.05±0.14 cm2/yr, p<0.01). Significantly more patients from mild AS in ESRD progressed to moderate to severe AS compared to control group (32% vs. 9%, p=0.02), while moderate AS showed similar progression in both group (Figure). Accelerated AS group in ESRD patients had significantly larger left atrial volume Index (LAVI) (p<0.01), larger stroke volume (p<0.01) and higher log PTH (p=0.04) compared to non-accelerated group. In multivariate analysis, LAVI≥42ml/m2 (HR 2.2, 95% CI 1.10-4.80, p=0.04) and higher log PTH (HR 2.9, 95% CI 1.10-8.04, p=0.04) were associated poor clinical outcome even after controlling for age and baseline LDL cholesterol. Conclusion: AS in ESRD progress in more accelerated manner compared to those with normal kidney function, even in mild to moderate AS. Therefore, more frequent follow up with proper risk stratification by assessing hemodynamic and metabolic characteristics, such as LAVI and PTH, may benefit ESRD patients to reduce clinical events.