DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Purpose: Echocardiographic characteristics that predict the progression of moderate aortic valve stenosis (AS) are lacking. The aim of the present study is to evaluate the prognostic value of left ventricular hypertrophy (LVH), diastolic dysfunction (DD) and pulmonary artery hypertension (PAH) in patients with moderate AS.
Methods and Results: A total of 109 patients with asymptomatic moderate AS (age 72 ± 10 years; females: 48 (44%) were included in this prospective study. Echocardiography was performed at baseline and at follow-up every six months. Patients with concomitant valvular defects, hypertrophic cardiomyopathy or chronic obstructive pulmonary disease were excluded. The primary endpoint was progression to severe AS with indication for treatment or the onset of symptoms. Moderate AS was defined by current guideline criteria. Left ventricular ejection fraction (LVEF), presence of LVH (LV mass index, males: > 115g/m2, females: > 95 g/m2), DD (E/e’ > 14) and PAH (maximum regurgitant velocity of tricuspid valve (TRVmax) > 2.8m/s) were assessed. Moderate AS patients were divided into 4 subgroups based on the number of these secondary cardiac alterations: (0) no; (1) one; (2) two; (3) three cardiac alterations. The change of the effective aortic orifice area (EOA – by continuity equation) was related to the time interval between baseline and follow-up (=EOA/days).
Moderate AS patients showed (0) no secondary cardiac alteration in 17% (n=18), (1) one alteration in 43% (n=47), (2) two in 22% (n=24) and (3) three in 18% (n=20). Among the AS subgroups, no significant differences were observed for age or other comorbidities. Echocardiographic parameters are summarised in Tab. 1. In general, moderate AS patients with ≥ two cardiac alterations showed higher mean pressure gradients (mPG), LV mass index and E/e’ (p <0.05). In contrast to baseline, moderate AS patients with ≥ two cardiac alterations showed significantly higher EOA at follow-up (p <0.05, mean follow-up 954 ± 537 days). Further, EOA/days was significantly higher in these patients ((0) -0.004; (1) -0.006; (2) -0.013; (3) -0.019; p< 0.05, Fig.1a). As shown in Fig.1b, AS severity has changed to severe AS earlier in AS patients with ≥ two secondary cardiac alterations.
Conclusion: In 40% of patients with moderate AS ≥ two secondary cardiac alterations (LV hypertrophy, DD and PAH) were observed. The presence ≥ two of these secondary cardiac alterations is associated with rapid progression of moderate AS to severe AS.
Tab.1 Echocardiographic Parameters of subgroups of patients with moderate AS
|
|
(0)n=18 |
(1) n=47 |
(2) n=24 |
(3) n=20 | ||||
|
|
baseline |
follow-up |
baseline |
follow-up |
baseline |
follow-up |
baseline |
follow-up |
|
EOA[cm2] |
1.34±0.23 |
1.37±0.19 |
1.30±0.25 |
1.21±0.25 |
1.34±0.21 |
1.06±0.23 |
1.34±0.16 |
1.02±0.29 |
|
mPG[mmHg] |
21.47±4.56 |
22.44±5.41 |
20.86±7.79 |
22.61±8.51 |
27.66±8.59 |
30.23±8.14 |
29.3±7.95 |
33.8±8.36 |
|
LVEF[%] |
62.2±6.88 |
60.1±8.45 |
58.1±9.67 |
57.3±7.02 |
59.3±7.95 |
57.8±9.31 |
58.2±9.87 |
56.4±9.75 |
|
LV mass index[g/m2] |
89.9±14.18 |
95.3±23.29 |
114.9±23.51 |
116.5±25.66 |
126.7±26.55 |
133.4±27.50 |
129.3±29.41 |
135.8±22.65 |
|
E/e’ |
10.5±2.12 |
11.4±3.18 |
11.9±2.69 |
13.0±3.37 |
16.7±3.72 |
17.1±3.68 |
19.3±5.67 |
19.1±6.40 |
|
TRVmax[m/s] |
2.5±0.23 |
2.5±0.20 |
2.8±0.36 |
2.9±0.31 |
2.8±0.38 |
3.0±0.55 |
3.1±0.35 |
3.1±0.39 |
https://dgk.org/kongress_programme/jt2021/aP1416.html