Progression of Aortic Stenosis and Long-term Follow-Up in Women

Ezra Amsterdam

doi:10.31579/2641-0419/147

Abstract

Data on the rate of progression of aortic stenosis (AS) in women are limited. We retrospectively studied 95 female patients (age 75 ± 13 yrs) with aortic valve area (AVA) <2.0 cm2 (mild AS 1.5-1.9 cm2, moderate AS 1.0-1.4 cm2, severe AS <1.0 cm2). All patients underwent serial transthoracic echocardiography. We determined annual AVA decrease (rate of AS progression) by 3 approaches, each of which was applied to the entire cohort: 1) as a single group; 2) in the 3 subgroups of mild, moderate and severe AS; and 3) in the rapid and slower progressors. Study endpoints were aortic valve replacement (AVR) and all-cause mortality. The mean duration of follow-up was 4.5 ± 2.9 years. Mean rate of reduction in AVA for the total study group was 0.14 ± 0.16 cm2/yr and was directly related to presence of hypertension and baseline AVA, and inversely related to follow-up duration (all p<0.05). The annualized decrease in AVA for each of the subgroups of mild, moderate and severe AS at baseline was 0.21±0.31 cm2, 0.13±0.11 cm2, 0.11±0.09 cm2, respectively (p<0.0001). Rapid progression of AS (decrease in AVA ≥0.20 cm2/yr) occurred in 21% of patients (n=20) and was associated with baseline hypertension (p=0.03) and inversely related to follow-up duration (p=0.0007). Rapid progressors had shorter follow-up than slower progressors (20 vs. 42 mos, p=0.002). Event-free survival with end-points of death (n=65) or surgical/transcatheter AVR (n=24) at 1, 3, and 5 years, respectively, was 93%, 66% and 40% for mild AS; 96%, 72% and 48% for moderate AS; and 93%, 38% and 24% for severe AS. Thus, event-free survival at 5 years in patients with baseline severe AS was approximately half that of patients with AS of mild or moderate severity. In addition, event-free survival at 1 year in slower progressors was 92% and in rapid progressors was 70%.

Highlights

Aortic stenosis (AS) is the most common valvular heart disease in developed countries, affecting 2-7% of persons >65 years old [1]
Transthoracic echocardiograms were performed with standard techniques according to the American Society of Echocardiography guidelines [1618]
The peak systolic transaortic valve jet velocity was determined from the continuous Doppler flow velocity signal across the aortic valve in apical views and the peak and mean aortic valve systolic gradients were calculated from the modified Bernoulli equation

Summary

Introduction

Aortic stenosis (AS) is the most common valvular heart disease in developed countries, affecting 2-7% of persons >65 years old [1]. Many of the factors associated with development of AS parallel those for atherosclerotic vascular disease [2]. There is a paucity of data on the relation of these and other factors to progression of AS in women because, with few exceptions, women have been studied in mixed gender populations [3,4,5,6,7,8,9,10,11,12,13,14]. Rate of progression of AS is an essential aspect of patient management, especially in terms of valve replacement [2,3,4,5,6,7,8].

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Results

Conclusion