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Cardiologists are seeing increasing numbers of patients with calcific aortic stenosis (AS) as the age distribution of the population shifts toward the elderly in developed countries. Although we now have identified several clinical and genetic factors associated with calcific AS, recognize that about 50% of patients have an underlying bicuspid aortic valve, and have an elementary understanding of the disease process as the tissue level, as yet there is no medical therapy to prevent worsening AS. Instead, the mainstay of clinical management is periodic monitoring for disease progression and symptom onset. However, the optimal monitoring interval is unclear given marked heterogeneity in the rate of anatomic and hemodynamic changes in valve function.
In this issue of Heart, Dr Nguyen and colleagues (see page 943) report AS progression in 149 patients enrolled in two prospective studies. The average increase in mean transvalvular gradient was +3±3 mm Hg/year with a mean increase in CT aortic valve calcification of +188±176 AU/year. Baseline AS severity was the strongest predictor of disease progression, with more rapid progression in those with more severe disease (figure 1). These data support current guideline recommendations to repeat echocardiographic imaging in adults with Stage B mild AS (aortic velocity 2.0 to 2.9 m/s) every 3 to 5 years, moderate AS (velocity 3.0 to 3.9 m/s) every 1–2 years, and asymptomatic severe AS (Stage C, velocity 4 m/s or higher) every 6 to 12 months.
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