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Rate of progression of valvular aortic stenosis in adults
P Faggiano1, G Ghizzoni, A Sorgato
1Division of Cardiology, S. Orsola Hospital, Brescia, Italy.
Insights
Doppler echocardiography accurately tracks the progression of aortic stenosis (AS). This noninvasive method revealed significant increases in peak velocity and gradient, alongside a decrease in aortic valve area over time.
Area of Science:
- Cardiology
- Medical Imaging
- Hemodynamics
Background:
- Traditionally, cardiac catheterization assessed valvular aortic stenosis (AS) severity.
- Doppler echocardiography offers a noninvasive and accurate alternative for AS evaluation.
- Serial assessments are crucial for understanding AS progression.
Purpose of the Study:
- To assess the progression of isolated valvular aortic stenosis (AS) using serial Doppler echocardiography.
- To evaluate changes in hemodynamic parameters over a follow-up period.
- To correlate AS progression with clinical outcomes.
Main Methods:
- Serial Doppler echocardiography in 45 adult patients with isolated AS.
- Measurements included left ventricular outflow tract velocity, peak aortic flow velocity, peak gradient, and aortic valvular area.
- Follow-up duration ranged from 6 to 45 months (mean 18 months).
Main Results:
- Mean peak velocity increased from 4 +/- 0.7 to 4.7 +/- 0.8 m/s (p < 0.01).
- Mean peak gradient increased from 64 +/- 30 to 88 +/- 30 mm Hg (p < 0.01).
- Mean aortic area decreased from 0.75 +/- 0.3 to 0.6 +/- 0.15 cm2 (p < 0.01).
Conclusions:
- Doppler echocardiography effectively monitors the hemodynamic progression of aortic stenosis.
- AS progression is characterized by increasing flow velocity and gradient, and decreasing valve area.
- These hemodynamic changes correlate with increased symptoms and adverse cardiac events.
Abstract:
Until recently the hemodynamic severity of valvular aortic stenosis (AS) was evaluated only by cardiac catheterization. Now, Doppler echocardiography allows a noninvasive and accurate assessment of AS severity and can be used to study its progression with time. The progression of AS was assessed during a follow-up period of 6 to 45 months (mean 18) by serial Doppler examinations in 45 adult patients (21 men and 24 women, mean age 72 +/- 10 years) with isolated AS. The following parameters were serially measured: left ventricular outflow tract diameter and velocity by pulsed Doppler, peak velocity of aortic flow by continuous-wave Doppler, to calculate peak gradient by the modified Bernoulli equation, and aortic valvular area by the continuity equation. At the initial observation, 13 of 45 patients (29%) were symptomatic (1 angina, 1 syncope and 11 dyspnea); during follow-up, 25 (55%) developed new symptoms or worsening of the previous ones (5 angina, 3 syncope and 17 dyspnea); 11 underwent aortic valve replacement and 3 died from cardiac events. Baseline peak velocity and gradient ranged between 2.5 and 6.6 m/s, and 25 and 174 mm Hg, respectively; aortic area ranged between 0.35 and 1.6 cm2. With time, mean peak velocity and gradient increased significantly from 4 +/- 0.7 to 4.7 +/- 0.8 m/s (p less than 0.01), and 64 +/- 30 to 88 +/- 30 mm Hg (p less than 0.01), respectively. A concomitant reduction in mean aortic area occurred (0.75 +/- 0.3 to 0.6 +/- 0.15 cm2; p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)