Abstract 19083: Predicting Aortic Valve Stenosis Progression: Discordance Between Anatomical and Hemodynamic Assessment of Aortic Valve Severity

Abstract

Background: The aortic valve area (AVA) is a marker of severity in aortic stenosis (AS) patients and has prognostic and treatment implications. However, there is limited data on predictors of severity progression. Methods: We analyzed 509 consecutive patients with AS who underwent paired echocardiographic studies >180 days apart. Anatomic and haemodynamic assessments of aortic valve stenosis severity were performed. Two hundred and sixty-seven patients (52%) had significant decrease (>20%) in AVA. We compare their baseline echocardiographic parameters to the group without progression. Results: The mean time interval between the paired studies (1252±910 days) and the mean LV ejection fraction (60±12%) were not significantly different between the two groups. One hundred and forty patients (28.8%) had mild AS (defined as AVA >1.5cm2), 217 (44.7%) had moderate AS (AVA 1 - 1.5 cm2) and 129 (26.5%) had severe AS (AVA <1.0 cm2); the decrease in AVA was greatest in those with mild AS (24.7% vs. 10.0% vs. 4.2%, p<0.001). Initial anatomic valve area but not pressure gradients predict progression (Table). Conclusions: The progression of AS appears fastest in those with mild AS. Determination of aortic valve area predicts progression. More frequent echocardiographic assessments may perhaps be performed in this group of patients for timely identification of patients who may benefit from subsequent intervention.