Moderate aortic stenosis: not as benign as it seems

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Severe aortic stenosis (AS) represents an important cause of morbidity and mortality, being aortic valve replacement the cornerstone for prognostic shift. Although mild and moderate AS are regarded as low risk, its benign course has recently been challenged. Purpose to evaluate cardiovascular (CV) events and identify prognostic factors in patients (pts) with moderate AS. Methods Single center observational study of pts with moderate AS in consecutive echocardiographic evaluations, during a minimum followup (FUP) of 3 years. Clinical characteristics and laboratory and echocardiographic data were collected at baseline and during follow-up (FUP). Analyzed events at FUP included pre-syncope/syncope, chest pain, dysrhythmic episodes, hospital admission due to heart failure (HF), death and CV death. Statistical analysis was performed using Chi-square and Mann-Whitney tests. Results a total of 78 pts (74±10 years; 52.6% males), were monitored during a mean FUP of 47±16 months. The main CV risk factors were systemic arterial hypertension (83.3%), hypercholesterolemia (66.7%) and diabetes (41%). Atrial fibrillation was present in 39.8% of pts. At baseline, the mean left ventricular ejection fraction (LVEF) was 62±8,6% and LV mass index (LV MI) was 118±30 g/m2. At FUP, NTproBNP was 7879 pg/ml and echocardiographic evaluation depicted a LVEF of 59±9.6% and a LVMI of 131±36 g/m2 (table 1). At FUP, 6% of pts had pre-syncope/syncope, 13% chest pain and about 5% presented with a dysrhythmic episodes, namely complete atrioventricular block and ventricular ectopic beats. All patients with dysrhythmias had a mean aortic gradient greater than 30 mmHg (p = 0.030). Lower LV EF at baseline (p = 0.005), greater index LV MI at baseline (p = 0.021) and at FUP (p = 0.016) and right ventricular dysfunction at FUP (p = 0.048) correlated with hospital admission due to HF (28% of pts). During FUP, 29% of pts died, 14% from CV cause. Greater LV MI at baseline (p = 0.046) and at FUP (p = 0.032) and worse LV EF at baseline (p = 0.016) were associated with death, while a higher LVMI at baseline (p = 0.034) showed correlation with CV death. Conclusion Contemporary risk stratification of moderate AS is still incipient. However, less than severe AS is associated with CV events and death. In our population, about 1/3 of pts died at mean 4 years FUP, half of them from CDV death, although they didn’t progress to severe AS. Further investigation is warranted to assess whether earlier intervention could improve outcomes in this subset of pts.