Progression of isolated aortic stenosis: Analysis of 29 patients having more than 1 cardiac catheterization

doi:10.1016/0002-9149(83)90531-3

The American Journal of Cardiology

Volume 52, Issue 8, 1 November 1983, Pages 1054-1058

https://doi.org/10.1016/0002-9149(83)90531-3 Get rights and content

Abstract

Factors related to progression of nonrheumatic aortic stenosis (AS) were analyzed in 29 adult patients who underwent serial hemodynamic studies over a mean of 71 months. AS was congenital in 8 patients and degenerative in 21. The patients were divided into 2 groups on the basis of the change in aortic valve area between the 2 studies. Twelve patients had a ≥ 25% reduction in aortic valve area (Group I) and 17 patients had < 25% decrease in aortic valve area (Group II). There were no significant differences between the 2 groups in age, interval between studies, cardiac output, left ventricular end-diastolic pressure, left ventricular peak systolic pressure and origin of AS (congenital or degenerative). Group I patients had significantly larger initial aortic valve areas than did Group II patients (1.3 ± 0.9 cm² versus 0.8 ± 0.4 cm², p = 0.02). Also, the initial peak transaortic pressure gradients were lower in Group I than in Group II (27 ±19 versus 58 ± 38 mm Hg, p = 0.01). Group I patients had a significantly greater increase in pressure gradient and a greater reduction in cardiac output than did Group II patients (24 ± 21 mm Hg in Group I versus−0.1 ± 24.5 mm Hg in Group II, p = 0.01, and −1.0 ± 1.3 liters/min in Group I versus 0.10 ± 1.4 liters/min in Group II, p = 0.03). Thus, AS progressed in 41 % of a selected group of patients who underwent repeated cardiac catheterization. The progression was not predictable. Although 10 patients (34%) had moderate aortic regurgitation (AR) in the second study, it was not related to the origin or rate of progression of AS. Mild AS tends to progress more than severe AS. Congenital AS appears to progress at the same rate as degenerative AS.

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In our study, we report the hemodynamics of AVB in an exclusive cohort of adult degenerative AS patients with midterm follow-up. The natural history of untreated AS is characterized by progression of the stenotic lesion at an average rate of 0.1 cm2 per year [21–32]. To date, no intervention (pharmacologic or mechanical) [33–37] has successfully decreased the rate of progression of AS.
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Forty-seven very high risk patients underwent AVB for AS between 2003 and 2009. The mean age was 82 years. Predismissal and interval transthoracic quantitative two-dimensional and Doppler echocardiography was performed in a core laboratory.
No patient had obstruction of the native aortic valve or the conduit during follow-up. The AVB effectively relieved left ventricular outflow tract obstruction (average peak gradient across the conduit was 5.6 ± 3.8 mm Hg). Native aortic valve stenosis did not progress after AVB (0.63 ± 0.16 cm² before surgery to 0.7 ± 0.24 cm² at latest follow-up more than 6 months; p = 0.16). Total stroke volume increased after AVB from 60 mL ± 22 mL to 107 mL ± 27 mL (p < 0.0001). Left ventricular outflow was distributed in a predictable fashion between the conduit and the native aortic valve, with 63% ± 10% of the flow directed to the conduit. Relative conduit flow remained stable (68% ± 8%) at latest follow-up more than 6 months (p = 0.17).
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Valvular heart diseaseProgression of isolated aortic stenosis: Analysis of 29 patients having more than 1 cardiac catheterization

Abstract

Am J Cardiol

Chest

Am Heart J

Am J Med

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Progression of isolated aortic stenosis: Analysis of 29 patients having more than 1 cardiac catheterization