Key result
Rapid first-year aortic jet velocity progression predicts ~85% more cardiac events in asymptomatic severe AS.
Why the study?
What are the predictors of rapid echocardiographic progression and cardiac events in patients with asymptomatic severe aortic stenosis?
Cohort (n=140)
No
What are the predictors of rapid echocardiographic progression and cardiac events in patients with asymptomatic severe aortic stenosis?
In asymptomatic severe aortic stenosis, a first-year aortic jet velocity progression of ≥0.22 m/s/year, dyslipidemia, and moderate-severe valve calcification independently predict future cardiac events, identifying high-risk patients who may benefit from early intervention.
Answers are grounded in this paper and cite their sources.
May aid risk stratification by first-year jet velocity progression in asymptomatic severe AS; leaves open whether early intervention improves outcomes.
BACKGROUND: The optimal timing of aortic valve replacement (AVR) is controversial in patients with asymptomatic severe aortic stenosis (AS) except when very severe. Prediction of progression of severe AS is helpful in deciding on the timing of AVR. The purpose of this study was to clarify the predictors of progression rate and clinical outcomes of severe AS. METHODS AND RESULTS: We retrospectively investigated 140 consecutive patients with asymptomatic severe AS (aortic valve area [AVA], 0.75-1.0 cm(2)). First-year progression rate and annual progression rate of AVA and of aortic jet velocity (AV-Vel) were calculated. Cardiac events were examined and the predictors of rapid progression and cardiac events were analyzed. The median follow-up period was 36 months. The median annual progression rate was -0.05 cm(2)/year for AVA and 0.22 m/s/year for AV-Vel. Dyslipidemia, moderate-severe calcification, and first-year AV-Vel progression ≥0.22 m/s/year were independent predictors of cardiac events. Cardiac event-free rate was lower in patients with AV-Vel first-year progression rate ≥0.22 m/s/year than in those with a lower rate. Diabetes and moderate-severe calcification were related to first-year rapid progression. CONCLUSIONS: The annual progression rate of severe AS was -0.05 cm(2)/year for AVA and 0.22 m/s/year for AV-Vel. Patients with first-year rapid progression or severely calcified aortic valve should be carefully observed while considering an early operation. (Circ J 2016; 80: 1863-1869).
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Nishimura et al. (2016) conducted a cohort in Asymptomatic severe aortic stenosis (n=140). First-year aortic jet velocity progression ≥0.22 m/s/year vs. First-year aortic jet velocity progression <0.22 m/s/year was evaluated on Cardiac events (cardiac death or adverse valve-related events) (HR 1.85, 95% CI 1.07-3.21, p=0.027). A first-year aortic jet velocity progression rate of ≥0.22 m/s/year independently predicted cardiac events in patients with asymptomatic severe aortic stenosis (HR 1.85).
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