Abstract
Background Fast progression of the transaortic mean gradient (P mean) is relevant for clinical decision making of valve replacement in patients with moderate and severe aortic stenosis (AS) patients. However, there is currently little knowledge regarding the determinants affecting progression of transvalvular gradient in AS patients. Methods This monocentric retrospective study included consecutive patients presenting with at least two transthoracic echocardiography examinations covering a time interval of one year or more between April 2006 and February 2016 and diagnosed as moderate or severe aortic stenosis at the final echocardiographic examination. Laboratory parameters, medication, and prevalence of eight known cardiac comorbidities and risk factors (hypertension, diabetes, coronary heart disease, peripheral artery occlusive disease, cerebrovascular disease, renal dysfunction, body mass index ≥30 Kg/m2, and history of smoking) were analyzed. Patients were divided into slow (P mean < 5 mmHg/year) or fast (P mean ≥ 5 mmHg/year) progression groups. Results A total of 402 patients (mean age 78 ± 9.4 years, 58% males) were included in the study. Mean follow-up duration was 3.4 ± 1.9 years. The average number of cardiac comorbidities and risk factors was 3.1 ± 1.6. Average number of cardiac comorbidities and risk factors was higher in patients in slow progression group than in fast progression group (3.3 ± 1.5 vs 2.9 ± 1.7; P=0.036). Patients in slow progression group had more often coronary heart disease (49.2% vs 33.6%; P=0.003) compared to patients in fast progression group. LDL-cholesterol values were lower in the slow progression group (100 ± 32.6 mg/dl vs 110.8 ± 36.6 mg/dl; P=0.005). Conclusion These findings suggest that disease progression of aortic valve stenosis is faster in patients with fewer cardiac comorbidities and risk factors, especially if they do not have coronary heart disease. Further prospective studies are warranted to investigate the outcome of patients with slow versus fast progression of transvalvular gradient with regards to comorbidities and risk factors.
Highlights
Stenosis of the aortic valve (AS) is a common clinical finding, especially in elderly patients
Especially the role of low-density lipoprotein cholesterol (LDL-C) and impact of statin therapy on aortic valve calcification have become the subject of controversial debates [16,17,18]. e European Society of Cardiology guidelines on the diagnosis and therapy of valvular heart diseases list rapid progression of aortic stenosis (AS) assessed by echocardiography as a prognostic indicator justifying early aortic valve replacement in asymptomatic patients, and fall short in providing any potential pathophysiological or mechanistic insights [19]. erefore, we investigated potential associations between the progression of AS assessed by progression of the transaortic mean gradient (Pmean) from serial transthoracic echocardiography and the number of cardiac comorbidities and risk factors in patients with moderate or severe AS in the current study
Left ventricular septal (IVSd) and posterior wall thickness (LVPWd), left ventricular ejection fraction (LVEF), AV Vmax, AV Pmax, and AV Pmean were significantly higher while aortic valve area calculated by the velocity time integral (AVA VTI) value was significantly lower in the fast progression group than in the slow progression group at follow-up echocardiography
Summary
Stenosis of the aortic valve (AS) is a common clinical finding, especially in elderly patients. Data regarding the impact of cardiac comorbidities and cardiovascular risk factors on the progression of the mean transaortic valve pressure gradient (Pmean) in patients with moderate or severe AS remain scarce in the literature until now. In this context, especially the role of LDL-C and impact of statin therapy on aortic valve calcification have become the subject of controversial debates [16,17,18]. Erefore, we investigated potential associations between the progression of AS assessed by Pmean from serial transthoracic echocardiography and the number of cardiac comorbidities and risk factors in patients with moderate or severe AS in the current study Especially the role of LDL-C and impact of statin therapy on aortic valve calcification have become the subject of controversial debates [16,17,18]. e European Society of Cardiology guidelines on the diagnosis and therapy of valvular heart diseases list rapid progression of AS assessed by echocardiography as a prognostic indicator justifying early aortic valve replacement in asymptomatic patients, and fall short in providing any potential pathophysiological or mechanistic insights [19]. erefore, we investigated potential associations between the progression of AS assessed by Pmean from serial transthoracic echocardiography and the number of cardiac comorbidities and risk factors in patients with moderate or severe AS in the current study
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