Impact of cardiovascular comorbidities on echocardiographic parameters in aortic stenosis

Comorbidities in aortic stenosis (AS) significantly impact treatment outcomes by influencing intervention timing, choice, and prognosis. Diseases affecting cardiac hemodynamics independently of AS progression may distort echocardiographic interpretation, risking misclassification of AS severity. Understanding how comorbidities alter key echocardiographic parameters may facilitate more precise evaluation.

To assess the impact of common cardiovascular comorbidities on echocardiographic evaluation of AS.

Medical records of 234 hospitalized patients with moderate/severe AS were retrospectively analyzed. Exclusion criteria included acute myocardial infarction, prior valvular surgery, and congenital heart defects. All patients underwent standard echocardiographic assessment during hospitalization.

Among the 234 patients (median age 76, 47.4% female), 85.0% had severe AS. The most prevalent comorbidities were hypertension (82.5%), chronic kidney disease (CKD, 45.3%), and type 2 diabetes (T2DM, 39.7%). Atrial fibrillation (AF) occurred in 33.8%, predominantly paroxysmal (49.4%). AF was associated with lower aortic valve mean pressure gradient (AVGmean, p = 0.001), peak velocity (Vmax, p < 0.001), and stroke volume (SV, p = 0.01), and higher left atrial (LA) area (p < 0.001). T2DM was associated with lower left ventricular ejection fraction (LVEF, p = 0.02), higher LA area (p = 0.02), and higher left ventricular mass (p = 0.01). Hypertension correlated with lower AVGmean (p = 0.04). CKD correlated with lower LVEF, AVGmean, SV, and cardiac output (p ≤ 0.02), but higher LA area and E/E' (p ≤ 0.01). Previous myocardial infarction was associated with lower LVEF (p = 0.01), aortic valve area (p = 0.002), SV (p = 0.004), and cardiac output (p < 0.001), but higher E/E' (p = 0.01).

Comorbidities significantly affect echocardiographic parameters in AS, potentially leading to miscategorization of severity. The observed differences highlight a need for more comprehensive evaluation in multimorbid patients.