Calcific aortic valve disease (CAVD) is the most common valvular heart disease in developed countries. CAVD ranges from aortic valve sclerosis (AVSc) with no functional impairment of the aortic valve to severe aortic valve stenosis (AVS). Especially, elderly patients are frequently affected and the prevalence of CAVD is thought to be increasing because of global aging and more accurate diagnostic screening methods. It remains however uncertain, which patients with AVSc are at particular high risk of developing aortic valve stenosis.

Objectives

In this retrospective study, we aimed to evaluate echocardiographic parameters to predict the progression of calcific aortic valve disease and thus to identify patients at very high risk to develop aortic valve stenosis.

Methods

In this study, we compared echocardiographic parameters between patients with aortic valve sclerosis at baseline, which either developed aortic valve stenosis at follow-up echocardiography (AVS group), or remained in the preceding stage with stable calcific aortic valve disease (AVSc groups) (Figure 1). 

We included a total of 222 patients with visual signs of aortic valve sclerosis without functional impairment of the aortic valve, defined as peak flow velocity below 2.5m/s at baseline echocardiography. Progression of CAVD was defined as an increase of the peak flow velocity > 2.5m/s with a delta of at least 100ms (D ³ 100ms); stable CAVD complied with a peak flow velocity below 2.5m/s and a delta < 100ms. Finally, we compared baseline and echocardiographic parameters between these two groups and evaluated their forecast value to develop aortic valve stenosis.

Results

Out of a total of 222 patients, 102 (45.9%%) have been assigned to the AVS groups, whereas 120 patients were in the AVSc group. The mean age of the study population was 72.9 (± 8.7) years and 64.9% of the patients were of male gender. The median time to follow-up echocardiography in the overall patient cohort was 1204 days (14/2135), with no significant difference between the groups (p = 0.57).

The AVS group was younger (71.2 ± 10.4 vs. 74.4 ± 6.0; p = 0.0013) and presented with higher rates of comorbidities such as chronic renal failure (32.4% vs. 16.7%; p = 0.006), dialysis-dependent kidney insufficiency (7.8% vs. 1.7%; p = 0.027) or diabetes (31.7% vs. 17.5%; p = 0.014) at baseline. Interestingly, patients with stable aortic valve sclerosis had more often atrial fibrillation (35.3% vs. 54.2%; p = 0.005) and accordingly more frequently the need to take an oral anticoagulation (38.2% vs. 55.0%; p = 0.013), which seems to have protective properties against the development of aortic valve stenosis. 

Progression of CAVD was associated with a higher peak flow velocity (p < 0.001), aortic valve area (p < 0.001) and mean pressure gradient (p < 0.001) at baseline. Patients in this group presented with significantly more calcification (p < 0.001) and thickening (p < 0.001) of the valve cusps and showed a reduced mobility of the left-coronary (LCC)-, right-coronary (RCC), and non-coronary cusp. Furthermore, the AVS group had significantly higher rates of concomitant advanced aortic valve regurgitation (AR) at baseline (AR grade II: 21.6% vs. 5.0; p < 0.001, AR grade III: 2.0% vs 0%; 0 < 0.001).

Conclusion

The acquisition of simple echocardiographic parameter can help to identify patients at particular high risk to develop aortic valve stenosis. 

Figure 1 – Study design