Rapid Progression Of Aortic Stenosis Research Articles

Chronic kidney disease is a key risk factor for aortic stenosis progression.

Rapid progression of aortic stenosis (AS) has been observed in patients undergoing dialysis, but existing cross-sectional evidence is contradictory in non-dialysis-dependent chronic kidney disease (CKD). The present study sought to evaluate whether CKD is associated with the progression of AS over time in a large cohort of patients with AS. We retrospectively studied all consecutive patients diagnosed with AS [peak aortic jet velocity (Vmax) ≥2.5m/s] and left ventricular ejection fraction ≥50% in the echocardiography laboratories of two tertiary centers between 2000 and 2018. The estimated glomerular filtration rate (eGFR) (mL/min/1.73m2) was calculated from serum creatinine values. Patients were divided into five CKD stages according to the baseline eGFR. Annual rates of change in the aortic valve area (AVA) were determined by a linear mixed-effects model. Among the 647 patients included, 261 (40%) had CKD. After a median follow-up of 2.9 (interquartile range 1.8-4.8) years, the mean overall rate of change in AVA was -0.077 (95% confidence interval -0.082; -0.073) cm2/year. There was an inverse relationship between the progression rate and kidney function. The more severe the CKD stage, the greater the AVA narrowing (P<.001). By multivariable linear regression analysis, the eGFR was also negatively associated (P<.001) with AS progression. An eGFR strata below 45mL/min/1.73m2 was associated with higher odds of rapid progression of AS than normal kidney function. During the clinical follow-up, event-free survival (patients free of aortic valve replacement or death) decreased as CKD progressed. Rapid progression of AS in patients with kidney dysfunction was associated with worse outcomes. Patients with CKD exhibit more rapid progression of AS over time and require close monitoring. The link between kidney dysfunction and rapid progression of AS is still unknown and requires further research.

Reclassification of moderate aortic stenosis based on data-driven phenotyping of hemodynamic progression

The management and follow-up of moderate aortic stenosis (AS) lacks consensus as the progression patterns are not well understood. This study aimed to identify the hemodynamic progression of AS, and associated risk factors and outcomes. We included patients with moderate AS with at least three transthoracic echocardiography (TTE) studies performed between 2010 and 2021. Latent class trajectory modeling was used to classify AS groups with distinctive hemodynamic trajectories, which were determined by serial systolic mean pressure gradient (MPG) measurements. Outcomes were defined as all-cause mortality and aortic valve replacement (AVR). A total of 686 patients with 3093 TTE studies were included in the analysis. Latent class model identified two distinct AS trajectory groups based on their MPG: a slow progression group (44.6%) and a rapid progression group (55.4%). Initial MPG was significantly higher in the rapid progression group (28.2 ± 5.6 mmHg vs. 22.9 ± 2.8 mmHg, P < 0.001). The prevalence of atrial fibrillation was higher in the slow progression group; there was no significant between-group difference in the prevalence of other comorbidities. The rapid progression group had a significantly higher AVR rate (HR 3.4 [2.4–4.8], P < 0.001); there was no between-group difference in mortality (HR 0.7 [0.5–1.0]; P = 0.079). Leveraging longitudinal echocardiographic data, we identified two distinct groups of patients with moderate AS: slow and rapid progression. A higher initial MPG (≥ 24 mmHg) was associated with more rapid progression of AS and higher rates of AVR, thus indicating the predictive value of MPG in management of the disease.

Relation of Monocyte Number to Progression of Aortic Stenosis

Rapid progression of aortic stenosis (AS) is associated with poor prognosis. However, the relation between monocyte number and AS progression is unknown. Here, we detected the relation between monocyte number and AS progression. We retrospectively analyzed 220 patients with AS with at least 2 echocardiograms with the maximal interval ≥180days from January 2016 to June 2021. AS severity was categorized by aortic jet velocity (Vmax) and mean pressure gradient. Rapid progression of AS was defined when Vmax increased ≥0.3m/s/year. Patients were divided into low and high monocyte groups according to the cut-off value of the receiver-operating characteristic curve. AS progression was compared between the 2 groups. Various models of binary logistic regression were used to reveal the association between monocyte number and rapid progression. During a median of 601days of echocardiographic follow-up (interquartile range 353 to 909), 52.7% of the population was in rapid progression. Patients in the high monocyte group had more rapid progression in both Vmax and mean pressure gradient (p=0.020 and p=0.030, respectively). The percentage of patients with severe AS was increased by 5.4% in the low monocyte group and 16.9% in the high monocyte group. Different models of binary logistic regression showed that the monocyte number was positively associated with the rapid progression. In conclusion, a higher monocyte number was associated with the rapid progression of AS.

Diabetes Is Associated With Rapid Progression of Aortic Stenosis: A Single-Center Retrospective Cohort Study

BackgroundMounting evidence indicates that rapid progression of aortic stenosis (AS) is significantly associated with poor prognosis. Whether diabetes accelerates the progression of AS remains controversial.ObjectivesThe purpose of the present study was to investigate whether diabetes was associated with rapid progression of AS.MethodsWe retrospectively analyzed 276 AS patients who underwent transthoracic echocardiography at least twice with a maximum interval ≥ 180 days from January 2016 to June 2021. AS severity was defined by specific threshold values for peak aortic jet velocity (Vmax) and/or mean pressure gradient. An increase of Vmax ≥ 0.3 m/s/year was defined as rapid progression. The binary Logistic regression models were used to determine the association between diabetes and rapid progression of AS.ResultsAt a median echocardiographic follow-up interval of 614 days, the annual increase of Vmax was 0.16 (0.00–0.41) m/s. Compared with those without rapid progression, patients with rapid progression were older and more likely to have diabetes (P = 0.040 and P = 0.010, respectively). In the univariate binary Logistic regression analysis, diabetes was associated with rapid progression of AS (OR = 2.02, P = 0.011). This association remained significant in the multivariate analysis based on model 2 and model 3 (OR = 1.93, P = 0.018; OR = 1.93, P = 0.022). After propensity score-matching according to Vmax, diabetes was also associated rapid progression of AS (OR = 2.57, P = 0.045).ConclusionsDiabetes was strongly and independently associated with rapid progression of AS.

Association of B-type natriuretic peptide with rapid progression in patients with aortic stenosis.

Rapid progression of aortic stenosis (AS) is associated with poor outcomes, and the impact of B-type natriuretic peptide (BNP) on AS progression remains unknown. The purpose of the present study was to investigate the association between BNP level and the AS progression rate. From January 2016 to June 2021, 200 AS patients with progression who had at least two transthoracic echocardiograms with a maximum interval of 180 days were retrospectively analyzed. Rapid progression of AS was defined as the annual increase of aortic jet velocity (Vmax) ≥0.3 m/s/year. For analyses, both the log-transformed BNP and the BNP ratio were used. The linear regression and binary logistic regression analyses were used to determine the association between BNP and the AS progression. At a median echocardiographic follow-up of 595 days, the annual median (interquartile) progression of Vmax was 0.26 (0.09-0.58) m/s/year. Patients with rapid progression had higher age, log BNP, and higher percentage of diabetes and male gender. Higher tertiles of log BNP and BNP ratio had more rapid increase in Vmax (p = 0.018 and 0.033, respectively). BNP ratio significantly correlated with Vmax progression in univariate and multivariate linear regression analyses (p < 0.001 and p = 0.001, respectively). Moreover, both the univariate and multivariate binary logistic regression analyses showed that the log BNP and BNP ratio were associated with the rapid progression of AS (p < 0.050 for all). Higher BNP was independently associated with the rapid progression of AS.

Progression of aortic stenosis in patients with bicuspid aortic valve.

Bicuspid aortic valve is the most common congenital heart defect and predisposes patients to developing aortic stenosis more frequently and at a younger age than the general population. However, the influence of bicuspid aortic valve on the rate of progression of aortic stenosis remains unclear. In 236 patients (177 tricuspid aortic valve and 59 bicuspid aortic valve) matched by initial severity of mild or moderate aortic stenosis, we retrospectively analyzed baseline echocardiogram at diagnosis with latest available follow-up echocardiogram. Baseline comorbidities, annualized progression rate of hemodynamic parameters, and hazard of aortic valve replacement were compared between valve phenotypes. Median echocardiographic follow-up was 2.6 (interquartile range [IQR] 1.6-4.2) years. Patients with tricuspid aortic stenosis were significantly older with more frequent comorbid hypertension and congestive heart failure. Median annualized progression rate of mean gradient was 2.3 (IQR 0.6-5.0) mmHg/year versus 1.5 (IQR 0.5-4.1) mmHg/year (p = .5), and that of peak velocity was 0.14 (IQR 0-0.31) m/s/year versus 0.10 (IQR 0.04-0.26) m/s/year (p = .7) for tricuspid versus bicuspid aortic valve, respectively. On multivariate analyses, bicuspid aortic valve was not significantly associated with more rapid progression of aortic stenosis. In a stepwise Cox proportional hazards model adjusted for baseline mean gradient, bicuspid aortic valve was associated with increased hazard of aortic valve replacement (hazard ratio: 1.7, 95% confidence interval [1.0-3.0], p = .049). Bicuspid aortic valve may not significantly predispose patients to more rapid progression of mild or moderate aortic stenosis. Guidelines for echocardiographic surveillance of aortic stenosis need not be influenced by valve phenotype.

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

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) &lt;2.0 cm2 (mild AS 1.5-1.9 cm2, moderate AS 1.0-1.4 cm2, severe AS &lt;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&lt;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&lt;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%.

ApoCIII-Lp(a) complexes in conjunction with Lp(a)-OxPL predict rapid progression of aortic stenosis

ObjectiveThis study assessed whether apolipoprotein CIII-lipoprotein(a) complexes (ApoCIII-Lp(a)) associate with progression of calcific aortic valve stenosis (AS).MethodsImmunostaining for ApoC-III was performed in explanted aortic valve leaflets in 68 patients with...

Progression in the severity of aortic stenosis according to race among those with advanced chronic kidney disease.

There is a higher prevalence of aortic stenosis (AS) in patients with advanced chronic kidney disease (CKD) and European ancestry. However, studies comparing AS progression in white and black patients in an advanced CKD population do not exist. Advanced CKD (stage IV-V) patients who were referred to the UNC Cardiorenal Clinic for pre-operative kidney transplant evaluation, and diagnosed with either AS (mild, moderate, or severe) or a left ventricular outflow tract velocity ≥2 m/s at any point between 2006-2016 were eligible for inclusion. Serial transthoracic echocardiograms over the 10-year period determined AS progression. All echocardiograms acquired after renal transplantation or aortic valve replacement were excluded. The rates of change of three indices of AS severity [mean gradient, aortic valve area (AVA), and aortic valve velocity] were compared between white and black patients. Mixed effects linear models with repeated measures were used to estimate the overall and race-stratified yearly rate of progression for each index, adjusted for age, sex, smoking status, dialysis, and baseline cholesterol. Of 1,283 patients, 140 (34% white, 66% black) developed or had baseline AS. Initially, 81% had no AS, 13% had mild, and 6% had moderate. White patients were more likely to be male and less likely to be on hemodialysis compared to black patients. No differences in AS severity (P=0.55) or age (60 vs. 58 years, P=0.34) were seen at baseline. In white vs. black patients, mean gradient increased at 1.90 (95% CI: 0.79, 3.01) mmHg/year vs. 1.46 (95% CI, 0.79, 2.14) mmHg/year, P=0.20, AVA decreased at -0.10 (95% CI: -0.15, -0.05) m2/year vs. -0.08 (95% CI: -0.11, -0.05) m2/year, P=0.13, and transvalvular velocity increased at 0.11 (95% CI: 0.04, 0.18) m/s/year vs. 0.07 (95% CI: 0.03, 0.11) m/s/year, P=0.09. Compared to black patients, white patients in an advanced CKD cohort may have exhibited more rapid progression of AS. Ours is the first study to analyze racial differences in such a population. A study with a larger sample size is needed to confirm our findings.

A case of mitral valve prolapse complicated by chordal rupture due to rapid progression of aortic stenosis

A case of mitral valve prolapse complicated by chordal rupture due to rapid progression of aortic stenosis

Predictors of Echocardiographic Progression in Patients With Mild Aortic Stenosis

Background and ObjectivesThe factors related to the progression of mild aortic stenosis (AS) remain unknown. We wanted to evaluate the long-term outcomes and predictors of echocardiographic progression in patients with mild AS.Subjects and MethodsWe prospectively included 103 consecutive asymptomatic patients (62.1±11.9 years, 31 males) with mild AS. Mild AS was defined as aortic valve (AV) thickening accompanied by a peak aortic jet velocity (AV Vmax) ≥2.0 and <3.0 m/sec, and rapid progression of AS was defined as an average annual increase in the AV Vmax ≥0.2 m/sec, and cardiac events were defined as cardiac death or AV replacement.ResultsDuring a median echocardiographic follow-up time of 6.0 years, the average change in the AV Vmax was 0.08±0.10 m/sec per year. The rate of progression was significantly associated with age, moderate-to-severe AV calcification and the baseline AV Vmax, but not with the serum cholesterol level. The baseline AV Vmax (2.6±0.3 m/sec vs. 2.2±0.3 m/sec, respectively, p<0.001) and the incidence of moderate-to-severe AV calcification (92.9% vs. 36.5%, respectively, p<0.001) were significantly higher in the rapid progression group than in the slow progression group. The 7-year cardiac event-free survival rate was lower in the rapid progression group than in the slow pro-gression group (87.5±8.3% vs. 100%, respectively).ConclusionThe progression of AS was slower than expected and it was related to age, the baseline AV Vmax and AV calcification. Because of the marked individual variability in progression, the patients showing rapid progression of AS need closer follow-up.

Prosthetic Aortic Valve Stenosis in End-Stage Renal Failure

Although renal failure is one of the known comorbidities associated with rapid progression of aortic stenosis, it is unclear whether hemodialysis alters the progression of prosthetic aortic valve stenosis. We describe a 79-year-old female who underwent bioprosthetic aortic valve replacement 8 years ago with stable prosthetic valve area for the initial 6 years. In the last two years, coinciding with the initiation of maintenance hemodialysis, she developed progressive prosthetic valve stenosis to the point of clinical decompensation. She underwent a second prosthetic aortic valve replacement with symptom resolution. This case suggests that circulating milieu in end-stage renal failure and dialysis can accelerate the progression of prosthetic aortic valve stenosis. More frequent clinical followup and surveillance echocardiogram for dialysis patients with bioprosthetic aortic valve may facilitate timely management of valvular stenosis.

Fast progression of aortic stenosis in rheumatoid arthritis

MOTS CLES Valvulopathie ; Stenose aortique ; Polyarthrite Valvular heart disease associated with rheumatoid arthritis is rare. In some cases, pathological studies have shown valve nodules and leaflet fibrosis that may extend to both the valvular annulus and, in the case of atrioventricular valves, the subvalvular apparatus. Valve regurgitation is common, but there are only few reports on valve stenosis. We report a case of rapid progression of aortic stenosis in a 67-year-old woman with longstanding active, uncontrolled and erosive rheumatoid arthritis for which an antitumour necrosis factor (TNF) therapy had been initiated. She had a 3-year history of stable asymptomatic moderate aortic stenosis (Fig. 1, Panel A) (maximal velocity: 2.3m/sec and 2.7m/sec, mean gradient: 17 and 22mmHg, aortic surface area: 0.8 cm2/m2 and 0.7 cm2/m2, respectively, 3 years and 3months before the acute event). An episode of acute heart failure occurred 5 days after the first infusion of etanercept. Transthoracic echocardiography revealed marked deterioration of the left ventricular ejection fraction (25—30%) and now severe low gradient aortic stenosis (mean gradient: 20mmHg, calculated aortic surface area 0.5 cm2/m2). Ejection fraction had been normal 3 months before the acute decompensation. The anti-TNF therapy was interrupted. Low-dose

Rapid Progression of Aortic Valve Stenosis in Patients With Chronic Hemodialysis: Report of Two Cases

The incidence of aortic stenosis (AS) is increasing, and the progression of AS is more rapid in chronic renal failure patients treated by dialysis than those in the general population. We present 2 cases of rapid progression of AS in chronic renal failure patients treated by dialysis. Both cases had no findings of AS at the first echocardiographic examination. After 3.5 years (case 1) and 2 years (case 2) later, severe AS was noted in both patients. The progression of AS was more rapid in our 2 cases compared with previous reports. Frequent echocardiographic examination should be performed to evaluate valvular calcification and stenosis in patients with chronic renal failure treated by chronic dialysis.

Bicuspid Aortic Valve Morphology and Interventions in the Young

The aim of this study was to determine whether the morphologic subtype of bicuspid aortic valve (BAV) is associated with valve intervention in the young. Analysis of BAV morphology is of prognostic relevance, as the fusion of right- and noncoronary leaflets (R-N) is associated with a greater degree of valve dysfunction compared with other subtypes. However, it is currently unknown whether morphologic differences translate into clinically relevant outcomes such as valve intervention. A nested cohort study was conducted on 310 patients with right- and left-coronary leaflet (R-L) and R-N fusion who were selected randomly from an inception cohort of 1,192 patients with BAV who were identified between 1986 and 1999. Supplementary information on clinical parameters was collected retrospectively from medical charts and databases. Median age at follow-up was 16.1 years (range 5.6 to 34.4 years), and 71% were male. The R-N fusion (n = 108) was strongly predictive of valve intervention when compared with The R-L fusion (n = 202; hazard ratio 4.5, 95% confidence interval [CI] 2.5 to 8.1; p < 0.0001). In a longitudinal analysis of 799 echocardiograms, R-N fusion also was associated with a greater progression of valve dysfunction. This was true for both increasing aortic valve gradient (generalized estimating equations [GEE] risk ratio 27.2, 95% CI 1.2 to 619.6, p = 0.0386) and aortic regurgitation (GEE risk ratio 2.4, 95% CI 1.3 to 4.3, p = 0.0029). The morphology of BAV is predictive of clinically important end points. The R-N fusion is associated with a more rapid progression of aortic stenosis and regurgitation and a shorter time to valve intervention.

Progression of Aortic Stenosis: Role of Age and Concomitant Coronary Artery Disease

To determine the spontaneous progression of valvular aortic stenosis and to delineate clinical factors related to progression, a longitudinal study, including 49 patients (aged 16 to 81 years), was performed. All patients had auscultatory findings of aortic stenosis and multiple Doppler echocardiograms separated by at least 11 months. Rapid progression of aortic stenosis was defined as an increase of maximal instantaneous pressure gradient by > or = 10 mm Hg per year. During a mean follow-up period of 32 months (11 to 66 months), maximal pressure gradient rose from 38 +/- 15 to 60 +/- 20 mm Hg in the entire study population, resulting in a median increase of 7.2 mm Hg per year. In 21 patients (43 percent), an increase of > or = 10 mm Hg per year was found; in this subgroup with rapid progression, patients were older (64 vs 53 years, p < 0.01) and coronary artery disease was more prevalent (38 percent vs 7 percent, p = 0.01). We conclude that nearly half the patients with initially mild to moderate valvular aortic stenosis reveal a progression of > or = 10 mm Hg per year.

Rapid progression of aortic stenosis and secondary hyperparathyroidism

Rapid progression of aortic stenosis and secondary hyperparathyroidism