Aortic stenosis is the major cause of valve disease in the Western world and a growing healthcare burden. We lack medication capable of slowing disease progression and so rely on aortic valve replacement in patients with severe disease and symptoms. Predicting when this will occur is challenging with the literature suggesting on average slow progression with wide individual variation (rate of change in the mean gradient of ∼3±3 mm Hg/year). Annual or biannual clinical review is therefore required in all patients with serial echocardiography performed in order to track progressive valve narrowing.1 This incurs significant costs and a method capable of predicting the future natural history of aortic stenosis and the likely timing of valve surgery could help streamline patient care.

It is on this background that Nguyen et al2 investigated whether an association exists between baseline aortic stenosis severity and the rate of disease progression. In 149 patients with largely mild and moderate disease, the average rate of haemodynamic progression after a mean follow-up of 2.9±1.0 years was again +3±3 mm Hg/year (mean gradient). As anticipated the fastest rates of progression were observed in those patients with the most advanced aortic stenosis …