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Predictors and progression of aortic stenosis in patients with preserved left ventricular ejection fraction.

Publication ,  Journal Article
Ersboll, M; Schulte, PJ; Al Enezi, F; Shaw, L; Køber, L; Kisslo, J; Siddiqui, I; Piccini, J; Glower, D; Harrison, JK; Bashore, T; Risum, N ...
Published in: Am J Cardiol
January 1, 2015

We aimed to characterize the hemodynamic progression of aortic stenosis (AS) in a contemporary unselected cohort of patients with preserved left ventricular ejection fraction. Current guidelines recommend echocardiographic surveillance of hemodynamic progression. However, limited data exist on the expected rate of progression and whether clinical variables are associated with accelerated progression in contemporarily managed patients with AS. We conducted a retrospective analysis of patients presenting with AS and explored the trajectory of AS mean gradient over time using generalized estimating equations and fit a longitudinal linear regression model with adjustment for baseline clinical variables. A total of 1,558 patients (median age 72; interquartile range 65 to 79) having mild (n = 982), moderate (n = 363), or severe AS (n = 213) were included. In patients with mild AS at baseline (n = 983), 303 (31%) had progressed to moderate/severe AS/AVR within 5 years of the index echo. In patients with moderate AS, 159 of 363 (44%) had progressed to severe AS/AVR within 2 years of the index echo. The annual change in mean gradient was dependent on baseline AS severity. Average annual increases in mean gradient were 6.8% (95% confidence interval 6.0 to 7.6) and 7.1% (95% confidence interval 4.8 to 9.3) in patients with mild and moderate AS, respectively. In the subset of patients with mild AS at baseline, age (p = 0.0310) and gender (p = 0.0270) had significant interaction with change in mean gradient over time. In patients with moderate AS, age (p <0.0001), gender (p = 0.0346), renal dysfunction (p = 0.0036), and hyperlipidemia (p = 0.0010) demonstrated significant interaction with change in mean gradient over time. In conclusion, although average disease progression was slower than previously reported, a significant proportion of patients with mild and moderate AS progressed to higher grades within the currently recommended time windows for echocardiographic follow-up.

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

January 1, 2015

Volume

115

Issue

1

Start / End Page

86 / 92

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Stroke Volume
  • Severity of Illness Index
  • Prospective Studies
  • Prognosis
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
  • Female
 

Citation

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Ersboll, M., Schulte, P. J., Al Enezi, F., Shaw, L., Køber, L., Kisslo, J., … Samad, Z. (2015). Predictors and progression of aortic stenosis in patients with preserved left ventricular ejection fraction. Am J Cardiol, 115(1), 86–92. https://doi.org/10.1016/j.amjcard.2014.09.049
Ersboll, Mads, Phillip J. Schulte, Fawaz Al Enezi, Linda Shaw, Lars Køber, Joseph Kisslo, Irfan Siddiqui, et al. “Predictors and progression of aortic stenosis in patients with preserved left ventricular ejection fraction.Am J Cardiol 115, no. 1 (January 1, 2015): 86–92. https://doi.org/10.1016/j.amjcard.2014.09.049.
Ersboll M, Schulte PJ, Al Enezi F, Shaw L, Køber L, Kisslo J, et al. Predictors and progression of aortic stenosis in patients with preserved left ventricular ejection fraction. Am J Cardiol. 2015 Jan 1;115(1):86–92.
Ersboll, Mads, et al. “Predictors and progression of aortic stenosis in patients with preserved left ventricular ejection fraction.Am J Cardiol, vol. 115, no. 1, Jan. 2015, pp. 86–92. Pubmed, doi:10.1016/j.amjcard.2014.09.049.
Ersboll M, Schulte PJ, Al Enezi F, Shaw L, Køber L, Kisslo J, Siddiqui I, Piccini J, Glower D, Harrison JK, Bashore T, Risum N, Jollis JG, Velazquez EJ, Samad Z. Predictors and progression of aortic stenosis in patients with preserved left ventricular ejection fraction. Am J Cardiol. 2015 Jan 1;115(1):86–92.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

January 1, 2015

Volume

115

Issue

1

Start / End Page

86 / 92

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Stroke Volume
  • Severity of Illness Index
  • Prospective Studies
  • Prognosis
  • Middle Aged
  • Male
  • Humans
  • Follow-Up Studies
  • Female