Patterns of progression of aortic stenosis: a longitudinal hemodynamic study.

To examine factors that might affect progression in valvular aortic stenosis (AS), we reviewed serial hemodynamic studies in 50 adult patients. Seven patients had congenital, 22 rheumatic and 21 degenerative-calcific aortic stenosis. The patients with calcific aortic stenosis were older (62 ± 6 vs 51 ± 9 years, p < 0.001) and had onset of murmur later in life. For all patients average values at first study include age 54 ± 4 years, a peak gradient of 38 ± 27 mm Hg and a calculated aortic valve area of 1.3 0.7 cm2. A mean of 3.5 ± 3 years later, the gradient was 57 + 30 mm Hg and aortic valve area 0.8 ± 0.4 cm". Peak left ventricular pressure increased 9 + 33 mm Hg and cardiac output decreased 0.5 + 0.2 I/mmn. Patients were divided into rapid (n = 21) and slow (n = 29) progressors; the rates of a change in aortic valve area were 0.30 0.21 and 0.02 ± 0.08 cm'/yr, respectively. Degenerative-calcific aortic stenosis was present in 76% of the rapid progressors and in 21% of slow progressors (p < 0.001); the groups also differed in that 48% of rapid progressors had a serial decrease in cardiac output of more than 1 I/min compared with 17% of slow progressors (p < 0.05). Furthermore, all patients who progressed into the critical range of severity of aortic stenosis (< 0.05 cm2) and developed left ventricular failure had degenerative-calcific aortic stenosis. We conclude that aortic stenosis progresses more rapidly in patients with degenerative-calcific than in those with congenital or rheumatic disease. In some patients, calculated aortic valve area is reduced due to an impaired ability of the failing left ventricle to move calcified leaflets rather than to an anatomic reduction in valve orifice.