Evolution of Echocardiographic Changes in Aortic Stenosis and the Association with Rapid Valvular Progression

Background Data on the chronological progression of myocardial changes during the course of aortic stenosis remain limited. In addition, it is unknown whether faster progression of aortic stenosis is associated with accelerated myocardial remodelling. Aims To describe the evolution of structural and functional echocardiographic changes over time in patients with moderate aortic stenosis and evaluate the association with rapid valvular progression. Methods and results In this retrospective longitudinal study, we included patients with a diagnosis of moderate aortic stenosis and serial echocardiograms. Changes in echocardiographic variables over time were analysed using linear mixed-effects models. This study included 467 patients with moderate aortic stenosis (median age 69 years, 36% female) with 2,806 echocardiograms (median of six per patient). Over a median follow-up of 4.3 years, 47% of patients developed severe aortic stenosis. Most echocardiographic variables changed linearly over time, with impaired relaxation, concentric remodelling and left atrial dilatation occurring early. Concentric hypertrophy developed only after aortic stenosis became severe. Rapid valvular progression was weakly associated with the rate of myocardial changes. Rapid progression of left ventricular mass index was accelerated by comorbidities and was associated with an increased risk of heart failure hospitalizations. Conclusions During progression of aortic stenosis, left atrial dilatation and impaired relaxation occur early, whereas concentric hypertrophy is a late finding. Rapid valvular progression is only weakly associated with enhanced myocardial remodelling, which is accelerated by comorbidities.