(Circulation. 2000;101:2497.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
New Insights Into the Progression of Aortic Stenosis
Implications for Secondary Prevention
From Loma Linda VA Medical Center University and Loma Linda University, Loma Linda, Calif.
Correspondence to Ramdas G. Pai, MD, FRCP(E), FACC, Director of Echocardiography, Research and Fellowship Programs, Department of Cardiac Sciences, #1413, King Fahd National Guard Hospital, PO Box 22490, Riyadh 11246, Kingdom of Saudi Arabia. E-mail ramdaspai{at}pol.net
Background—The risk factors affecting aortic stenosis (AS) progression are not clearly defined. Insights into this may allow for its secondary prevention.
Methods and Results—We investigated predictors of AS progression
in 170 consecutive patients with AS who had paired echocardiograms 
3
months (23±11) apart. Various clinical,
echocardiographic, and biochemical variables were
related to the change in aortic valve area (AVA). The annual rate of
reduction in AVA was 0.10±0.27 cm2 or 7±18% per year.
The reduction in AVA per year was significantly related to initial AVA
(r=0.46, P<0.0001), the mean aortic
valve gradient (r=0.27, P=0.04),
left ventricular (LV) outflow tract velocity
(r=0.26, P=0.001), and LV
end-diastolic diameter (r=0.20,
P=0.04) and marginally to serum creatinine
level (r=0.15, P=0.08). Patients with a
rate of reduction in AVA faster than the mean had higher serum
creatinine (P=0.04) and calcium
(P=0.08) levels. Those with a serum
cholesterol level >200 mg/dL had a rate of AVA reduction
roughly twice that of those with a lower cholesterol level
(P=0.04). Stepwise multiple regression analysis
identified initial AVA, current smoking, and serum calcium level as the
independent predictors of amount of AVA reduction per year.
Conclusions—Absolute and percentage reduction in AVA per year in those with AS is greater in those with milder degrees of stenosis and is accelerated in the presence of smoking, hypercholesterolemia, and elevated serum creatinine and calcium levels. These findings may have important implications in gaining further insights into the mechanism of AS progression and in formulating strategies to retard this process.
Key Words: valves • heart diseases • prevention • echocardiography
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