Aortic stenosis progression by different echocardiographic parameters: which one should we use?

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): - Spanish Ministry of Economy and Competitiveness through the Carlos III Institute of Health (Fondo de Investigación Sanitaria). - Post-residency research contract. Medical Research Institute Hospital La Fe (IIS La Fe), Valencia, Spain. Introduction Aortic stenosis (AS) is a significant health problem, particularly in older individuals, and is the most common valve disease necessitating surgical or percutaneous intervention. Echocardiography is central in the diagnosis, management and assessment of disease progression of AS patients. AS severity grading is based on 3 parameters: aortic valve area by continuity equation (AVA), mean gradient (MG), and peak aortic valve velocity (Vmax). Although the AVA is relevant in low gradient situations, its calculation is more complex and therefore may show greater technical variability. Knowing the differences between the 3 parameters to assess progression may be useful in clinical practice. Purpose Assess the differences between the 3 main quantitative parameters to detect the progression of disease in patients with AS. Methods We retrospectively analyzed a cohort of 130 patients with a diagnosis of isolated AS (without other valve disease) and 2 echocardiograms performed at an interval of more than 1 year, in which the AVA calculated using the continuity equation was measured. The annual rate of change of AVA, MG, and Vmax, and the proportion of patients with progression based on predefined criteria (AVA decrease >0.2 cm2, MG increase > 10 mmHg, and Vmax > 30 cm/s) were analyzed. Results The mean interval between the 2 echocardiograms was 26 (9) months. Globally, the annual rate of change was small for the 3 parameters, with a higher proportion of relevant progression considering Vmax (49.2%), and lower for MG (28.5%), being intermediate for AVA (36.1%) (Table). Of the 47 patients with AS progression by AVA criteria, progression by Vmax criteria was observed in 32 patients (68%), and only in 19 patients (40%) by MG criteria. Conclusions Although the criterion for progression of AS based on Vmax is considered in the clinical practice guidelines, in many patients it is not associated with relevant changes in AVA or MG. Discrepancies on AS progression across different parameters is frequent and may lead to inconsistent decision making.