BACKGROUND
The assessment of changes in symptomatic/functional status during follow-up is critical
to determine the optimal timing for intervention in asymptomatic patients with severe
aortic valve stenosis (AS). However, there is very few data on the correlation between
the progression of AS severity and the deterioration of symptomatic status. Fast progression
of hemodynamic severity of AS (i.e. annualized progression of peak jet velocity [Vpeak]
≥30 cm/s) is among the risk markers (Class IIa) recommended in the guidelines to trigger
early intervention in asymptomatic severe AS. We investigated the association between
the progression of AS hemodynamic severity and the change in functional status during
follow-up of patients with asymptomatic mild-to-moderate AS at baseline.
METHODS AND RESULTS
285 patients with AS (mean age 65±13 years, 28% women) prospectively recruited in
the PROGRESSA study (NCT01679431) were included in this analysis. Functional status
was evaluated using the New York Heart Association (NYHA) classification. Baseline
NYHA class was similar (class I, II, III: 57%, 41%, 2% versus 58%, 41%, 1%; p=0.75)
between patients with moderate (i.e. Vpeak progression ≥12 cm/s/year; median of cohort)
versus those with slow AS progression rate. During a mean follow-up time of 3.9±2.4
years, patients with moderate AS progression rate had larger increase in NYHA class
compared to those with slow progression (+0.13±0.48 versus +0.01±0.21 class/year;
p=0.008). From baseline to 2 years, a significant worsening of NYHA class occurred
but only in the moderate AS progression group (Figure 1). In comprehensive multivariable
analysis, AS progression rate remained significantly associated with the annualized
change in NYHA class (p=0.04). A total of 156 clinical events (110 AVR and 46 deaths)
occurred during a mean follow-up of 1.1±1.5 years after the last echocardiographic
visit. Patients with an increase of at least one NYHA class (n=70) had significantly
higher risk of events (adjusted hazard ratio: 1.75 [95% confidence interval: 1.12-2.75];
p=0.01).
CONCLUSION
In this prospective cohort of patients with mild-to-moderate AS at baseline, a moderate
progression rate of AS severity was associated with a significant deterioration of
patients’ functional status at 2 years follow-up and with increased risk of major
adverse clinical events, thereafter. The decline in functional status often occurs
early in the course of the disease and is in large part determined by the progression
rate of AS hemodynamic severity.
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© 2021 Published by Elsevier Inc.
