From the Guidelines
The annual progression rate of aortic stenosis is approximately 0.3 m per second per year in jet velocity, 7 mm Hg per year in mean pressure gradient, and 0.1 cm2 per year in valve area reduction, as estimated in invasive and noninvasive studies 1.
Key Factors Influencing Progression Rate
- The rate of progression of aortic stenosis can vary significantly between individuals, with some patients experiencing more rapid deterioration than others 1.
- Factors such as age, sex, hypertension, smoking, serum low-density lipoprotein and lipoprotein(a) levels, and diabetes mellitus can influence the progression rate of aortic stenosis 1.
- The presence of aortic sclerosis, defined as valve thickening without obstruction to ventricular outflow, can also be a precursor to aortic stenosis and is associated with adverse clinical outcomes 1.
Importance of Regular Monitoring
- Regular clinical follow-up is mandatory in all patients with asymptomatic mild to moderate aortic stenosis to track progression rates individually 1.
- Echocardiographic monitoring is essential to determine the optimal timing for intervention before symptoms develop or left ventricular dysfunction occurs.
- The frequency of monitoring may vary depending on the severity of stenosis, with more frequent monitoring recommended for patients with moderate to severe stenosis.
From the Research
Annual Progression Rate of Aortic Stenosis
The annual progression rate of aortic stenosis (AS) can be assessed by various parameters, including mean gradient (MG), peak velocity (PV), peak gradient (PG), and aortic valve area (AVA).
- The pooled annualized progression of MG was +4.10 mm Hg 2
- The pooled annualized progression of AVA was -0.08 cm2 2
- The pooled annualized progression of PV was +0.19 m/s 2
- The pooled annualized progression of PG was +7.86 mm Hg 2
- Initial changes in Vmax and MG among patients with mild or moderate AS are strongly associated with risk of progression to severe AS 3
- A large variability in observed AS progression was found between studies 4
Factors Affecting Progression Rate
Several factors can affect the progression rate of AS, including:
- Baseline AS severity: Increasing baseline severity of AS was predictive of higher rates of progression for MG, PV, and AVC 2
- Individual variability: There is significant interindividual variability in the rate of AS progression [(3,5)]
- Sex: The impact of sex on AS progression rate is unclear, with only a few studies reporting progression rates stratified by sex 2
Measurement of Progression Rate
The progression rate of AS can be measured using various methods, including: