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Progression of aortic stenosis in elderly patients over long-term follow up

L G Kearney1, M Ord, B F Buxton

  • 1Department of Cardiology, Austin Health, VIC, Australia. leighton.kearney@austin.org.au

International Journal of Cardiology
|April 10, 2012
PubMed

Insights

Elderly patients with aortic stenosis (AS) show significant hemodynamic progression, influenced by AS severity, renal function, and valve calcification. These factors predict rapid progression, guiding surveillance strategies for older adults with AS.

Area of Science:

  • Cardiology
  • Geriatrics
  • Valvular Heart Disease

Background:

  • The natural history and progression of aortic stenosis (AS) in elderly populations are not well-defined.
  • Understanding long-term outcomes is crucial for managing this common condition in older adults.

Purpose of the Study:

  • To assess the rates and predictors of hemodynamic progression of AS in elderly patients.
  • To evaluate the composite endpoint of aortic valve replacement (AVR) or death over long-term follow-up.

Main Methods:

  • Prospective enrollment of 239 elderly patients (>60 years) with AS from 1988-1994, with follow-up until 2008.
  • Progression analysis included 147 patients with at least two echocardiograms >6 months apart.
  • Baseline demographics, comorbidities, and echocardiographic parameters were recorded; follow-up was censored at AVR or death.

Main Results:

  • Annualized mean aortic valve gradient progression rates increased with AS severity (mild: 4±4, moderate: 6±5, severe: 10±8 mmHg/year; p<0.001).
  • Five-year event-free survival was significantly lower in moderate (23±7%) and severe (20±10%) AS compared to mild AS (66±5%).
  • Independent predictors of rapid progression included baseline AS severity, aortic valve calcification, severe renal impairment, and anemia.

Conclusions:

  • Hemodynamic progression of AS in the elderly is significantly influenced by baseline AS severity, renal function, aortic valve calcification, and a history of anemia.
  • These identified predictors can help stratify risk for rapid progression.
  • Frequent clinical and echocardiographic surveillance is recommended for elderly patients at high risk of AS progression.
Abstract

Keywords:
Aortic stenosisComorbidityElderlyProgressionRenal failure

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