From the Guidelines
For patients with mild aortic stenosis, a follow-up ultrasound schedule of every 3-5 years is recommended to monitor disease progression, as supported by the 2020 ACC/AHA guideline for the management of patients with valvular heart disease 1. This recommendation is based on the understanding that mild aortic stenosis typically progresses slowly, but individual variability exists, particularly in older patients and those with more severe leaflet calcification. Key factors to consider when determining the follow-up schedule include:
- Individual risk factors such as age, presence of coronary artery disease, hypertension, and other valve abnormalities
- Presence of concerning symptoms such as chest pain, shortness of breath, or dizziness
- Signs of more rapid progression on previous studies, which may warrant shorter follow-up intervals of every 1-2 years During follow-up evaluations, physicians will assess:
- Valve area
- Pressure gradients across the valve
- Left ventricular function Regular clinical evaluations between imaging studies are crucial to detect any new symptoms, and patients should report any new or worsening symptoms promptly rather than waiting for scheduled appointments. The monitoring approach is guided by the natural history of aortic stenosis, which typically progresses slowly, but can accelerate in some individuals, particularly those with calcification or bicuspid valves, as noted in the 2020 ACC/AHA guideline 1.
From the Research
Follow-up Ultrasound Schedule for Mild Aortic Stenosis (AS)
The recommended follow-up ultrasound schedule for patients with mild aortic stenosis (AS) varies depending on the gradient slope and other factors.
- For patients with a gradient slope < 1.1, evaluation every 4 or 5 years is recommended 2.
- For patients with a gradient slope > 1.2, evaluation every 1 or 2 years seems prudent 2.
- In general, for patients with mild AS, clinical and echocardiographic surveillance at intervals of 3 to 5 years is recommended 3.
Disease Progression and Management
Aortic stenosis is a progressive disease that requires long-term follow-up at consistent intervals 2.
- The slope of the transaortic gradient (change of gradient/time) is predictive of outcome, with a hazard ratio of 1.69 2.
- At least 17% of patients with very mild aortic stenosis progress to require operation 2.
- Management of mild to moderate AS consists of patient education, clinical and echocardiographic surveillance, and treatment of hypertension, hyperlipidemia, and cigarette smoking as indicated 3.
Comparison with Other Conditions
Very severe AS has poorer survival and valve-related event-free survival than severe AS 4.
- The 3-year survival and valve-related event-free survival of asymptomatic very severe AS are comparable with symptomatic severe AS, but they are significantly worse than asymptomatic severe AS 4.
- Moderate AS and reduced left ventricular ejection fraction constitute a clinical entity that has been proposed as a therapeutic target for transcatheter aortic valve replacement (TAVR) 5.