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Progression of aortic stenosis in adult men. Detection by noninvasive methods
Insights
Noninvasive scoring effectively detects aortic stenosis progression in elderly men. This method identifies worsening disease over three years, aiding in early intervention for aortic stenosis.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Tools
Background:
- Aortic stenosis (AS) severity is crucial for patient management.
- Noninvasive methods are sought to track AS progression accurately.
- Existing scoring systems require validation for monitoring disease advancement.
Purpose of the Study:
- To evaluate a noninvasive scoring system for detecting the progression of aortic stenosis (AS).
- To assess the utility of a 7-variable noninvasive score in identifying changes in AS severity over time.
Main Methods:
- A validated 7-variable noninvasive scoring system (range 0-16) was applied.
- The study included patients with prior hemodynamic AS assessments.
- Progression was assessed via repeat hemodynamic studies and noninvasive scoring over 1-9 years.
Main Results:
- In 11 patients with repeat hemodynamic studies, mean aortic valve gradient increased, and valve area decreased significantly (p < 0.005).
- Noninvasive scores increased from 0.7 to 7.1 in this group (p < 0.005).
- In 35 patients with repeat noninvasive studies, 63% showed a score increase ≥3, and 57% reached a score ≥5, indicating probable severe AS.
Conclusions:
- The noninvasive scoring system effectively detects progression of aortic stenosis.
- Approximately 60% of elderly male patients show AS progression over three years.
- Simple, noninvasive methods can reliably identify worsening aortic stenosis.
Abstract:
One hundred seventy-one patients with aortic stenosis (AS) who had hemodynamic studies were evaluated by a scoring system of the seven following noninvasive variables which our laboratory had developed to estimate the severity of AS: left ventricular hypertrophy (LVH) by ECG; visible aortic valve calcification by chest x-ray examination; loudness of A2; Q to peak of systolic murmur; T-time of the carotid pulse; LV ejection time; and LVH by M-mode echocardiography. The range of the severity score is 0 to 16, and a score greater than or equal to 5 has been shown correctly to identify 93 percent of patients with severe AS (valve area less than or equal to 1.0 cm2). The present study has applied this method to the detection of progression of AS. Eleven patients (mean age, 60.4 years) were studied who had hemodynamic studies performed two to nine years apart (mean, three years). Progression of stenosis occurred in all, with an increase in mean aortic valve gradient from 23 +/- 4.7 mm Hg to 46 +/- 6.5 mm Hg (p less than 0.005). Aortic valve area decreased from 1.5 +/- 0.18 cm2 to 0.88 +/- 0.10 cm2 (p less than 0.005). Noninvasive scores increased in these patients from 0.7 +/- 0.5 to 7.1 +/- 2.3 (p less than 0.005). Thirty-five patients (mean age, 62.4 years) had repeat noninvasive studies one to six years apart (mean 3 years). Twenty-two (63 percent) had an increase in the noninvasive score of greater than or equal to 3 points, and 20 (57 percent) attained a score of greater than or equal to 5, indicating probable severe AS. The mean initial severity score was 2.2 +/- 0.3, and at the end of a mean follow-up of three years, the score was 8.3 +/- 0.6 (p less than 0.005). It is concluded that in the elderly male, progression of AS over a three-year period occurs in about 60 percent of patients, and progression can be detected by simple, noninvasive methods.