TY - JOUR
T1 - Prediction of the Individual Aortic Stenosis Progression Rate and its Association With Clinical Outcomes
AU - Venema, Constantijn S.
AU - van Bergeijk, Kees. H.
AU - Hadjicharalambous, Demetra
AU - Andreou, Theodora
AU - Tromp, Jasper
AU - Staal, Laura
AU - Krikken, Jan A.
AU - van der Werf, Hindrik W.
AU - van den Heuvel, Ad F. M.
AU - Douglas, Yvonne L.
AU - Lipsic, Erik
AU - Voors, Adriaan A.
AU - Wykrzykowska, Joanna J.
N1 - Publisher Copyright: © 2024 The Authors
PY - 2024/4/1
Y1 - 2024/4/1
N2 - Background: The progression rate of aortic stenosis differs between patients, complicating clinical follow-up and management. Objectives: This study aimed to identify predictors associated with the progression rate of aortic stenosis. Methods: In this retrospective longitudinal single-center cohort study, all patients with moderate aortic stenosis who presented between December 2011 and December 2022 and had echocardiograms available were included. The individual aortic stenosis progression rate was calculated based on aortic valve area (AVA) from at least 2 echocardiograms performed at least 6 months apart. Baseline factors associated with the progression rate of AVA were determined using linear mixed-effects models, and the association of progression rate with clinical outcomes was evaluated using Cox regression. Results: The study included 540 patients (median age 69 years and 38% female) with 2,937 echocardiograms (median 5 per patient). Patients had a linear progression with a median AVA decrease of 0.09 cm2/y and a median peak jet velocity increase of 0.17 m/s/y. Rapid progression was independently associated with all-cause mortality (HR: 1.77, 95% CI: 1.26-2.48) and aortic valve replacement (HR: 3.44, 95% CI: 2.55-4.64). Older age, greater left ventricular mass index, atrial fibrillation, and chronic kidney disease were associated with a faster decline of AVA. Conclusions: AVA decreases linearly in individual patients, and faster progression is independently associated with higher mortality. Routine clinical and echocardiographic variables accurately predict the individual progression rate and may aid clinicians in determining the optimal follow-up interval for patients with aortic stenosis.
AB - Background: The progression rate of aortic stenosis differs between patients, complicating clinical follow-up and management. Objectives: This study aimed to identify predictors associated with the progression rate of aortic stenosis. Methods: In this retrospective longitudinal single-center cohort study, all patients with moderate aortic stenosis who presented between December 2011 and December 2022 and had echocardiograms available were included. The individual aortic stenosis progression rate was calculated based on aortic valve area (AVA) from at least 2 echocardiograms performed at least 6 months apart. Baseline factors associated with the progression rate of AVA were determined using linear mixed-effects models, and the association of progression rate with clinical outcomes was evaluated using Cox regression. Results: The study included 540 patients (median age 69 years and 38% female) with 2,937 echocardiograms (median 5 per patient). Patients had a linear progression with a median AVA decrease of 0.09 cm2/y and a median peak jet velocity increase of 0.17 m/s/y. Rapid progression was independently associated with all-cause mortality (HR: 1.77, 95% CI: 1.26-2.48) and aortic valve replacement (HR: 3.44, 95% CI: 2.55-4.64). Older age, greater left ventricular mass index, atrial fibrillation, and chronic kidney disease were associated with a faster decline of AVA. Conclusions: AVA decreases linearly in individual patients, and faster progression is independently associated with higher mortality. Routine clinical and echocardiographic variables accurately predict the individual progression rate and may aid clinicians in determining the optimal follow-up interval for patients with aortic stenosis.
KW - aortic stenosis
KW - risk prediction
KW - structural heart disease
KW - transcatheter aortic valve replacement
KW - valvular heart disease
UR - http://www.scopus.com/inward/record.url?scp=85186658194&partnerID=8YFLogxK
U2 - 10.1016/j.jacadv.2024.100879
DO - 10.1016/j.jacadv.2024.100879
M3 - Article
SN - 2772-963X
VL - 3
JO - JACC: Advances
JF - JACC: Advances
IS - 4
M1 - 100879
ER -