Key result
Rheumatic heart disease is linked to slower aortic valve area loss at ~0.04 cm²/year.
Why the study?
Calcific AS is prevalent in developed countries while RHD remains prevalent with low progression rates in developing countries, but comparative progression data are limited.
What are the progression rates of aortic stenosis in patients with calcific versus rheumatic etiology in Saudi Arabia?
Cohort (n=1,669)
No
What are the progression rates of aortic stenosis in patients with calcific versus rheumatic etiology in Saudi Arabia?
Aortic stenosis progression rates vary by etiology, with calcific AS in end-stage renal disease showing the fastest progression and rheumatic heart disease showing the slowest progression.
May support etiology-specific aortic stenosis surveillance; extends Western progression benchmarks to a Middle Eastern cohort but remains hypothesis-generating.
Study objective Calcific aortic stenosis (AS) is the most prevalent type of AS in developed countries. However, in developing countries, rheumatic heart disease (RHD), which has a low progression rate, remains the prevalent type. This study compared the progression rates of AS between the National Guard cohort and Western populations. Design This was a retrospective single-center cohort study. Participants Involving patients who underwent two echocardiographic examinations within an interval of at least 2 years. Main outcome measures Progression of aortic valve stenosis was assessed by measuring changes in the aortic valve area (AVA), peak aortic velocity, and mean aortic valve gradient. Results In total, 1669 patients (median follow-up: 6.9 years) were included in the analysis. The overall annual AVA progression rate was 0.074 ± 0.1 cm 2 /year (median: −0.061 cm 2 /year). Patients with RHD had lower progression rates than those without RHD (25%–35%; AVA: −0.036 [−0.042, −0.030] cm 2 /year). Patients with end-stage renal disease (ESRD) who exhibited calcific AS had the highest progression rate (AVA: −0.102 ± 0.096 cm 2 /year). The overall progression rate of AS for the National Guard cohort was lower across all groups compared with that in Western populations (AVA: −0.08 to 0.12 cm 2 /year). Conclusions Patients with ESRD who had calcific AS had the highest progression rate. Meanwhile, patients with RHD exhibited the lowest progression rate. The high prevalence of calcific AS in our study shows the importance of adherence to the American College of Cardiology/European Society of Cardiology guidelines for disease management.
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Elsherif et al. (2026) conducted a cohort in Aortic stenosis (n=1,669). Rheumatic heart disease (RHD) vs. Patients without RHD was evaluated on Progression of aortic valve stenosis (change in aortic valve area). Patients with rheumatic heart disease exhibited a lower aortic valve area progression rate (-0.036 cm2/year) than those without RHD, whereas those with end-stage renal disease had the highest.
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