Predictors of Echocardiographic Progression in Patients With Mild Aortic Stenosis

BACKGROUND AND OBJECTIVES The 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 METHODS We 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. RESULTS During 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). CONCLUSION The 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.