Progression of Calcific Aortic Stenosis and Its Association with Clinical Risk Factors

Abstract

Aim: Haemodynamic progression of Aortic stenosis (AS) from mild to severe obstruction usually occurs over 5-10 years or more. This study aimed to evaluate the rate of progression and contributing clinical factors in a cohort of patients from a small suburban Hospital in Queensland. Methods: Retrospective review of patients for the period 2006-2015. Patients with clinical and echocardiographic evidence of aortic sclerosis and AS were included. Clinical risk factors and echocardiographic haemodynamic data were recorded. Results: Of the 53 patients 22 were female. Age (years) ranged from 57 to 95, median at presentation being 79. Five patients (9%) had bicuspid aortic valve. Hypertension was the most common comorbidity (79%) followed by hypercholesterolaemia (40%) and diabetes (30%). Eight patients (15%) had sclerosis. During the follow-up 45% progressed to severe AS; 9 of them (17%) had mild AS initially.42% developed heart failure. Although more females tended to have severe AS (50% versus 42% male) in this study, males had a higher intervention rate (19% versus 14% female). Eight patients (15%) died, including a sudden death and another from complications of endocarditis, others causes were mostly attributed to co-morbid conditions. Conclusion: Though increasing age is the most common association in calcific aortic stenosis, presence of modifiable clinical factors like hypertension and hypercholesterolaemia may contribute to onset and progression of disease and adequate management of these may delay onset or progression. Mortality remains high even in less severe disease, due mostly to complicating co-morbidities of old age.