Journal of Cardiovascular Imaging

Korean Society of Echocardiography (한국심초음파학회)
권호 표지
DOI QR코드

DOI QR Code

Progression Rate of Aortic Valve Stenosis in Korean Patients

  • Ryu, Dong-Ryeol (Division of Cardiology, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Sung-Ji (Division of Cardiology, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Han, Hye-Jin (Division of Cardiology, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Hyun-Jong (Division of Cardiology, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Chang, Sung-A (Division of Cardiology, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Jin-Oh (Division of Cardiology, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Sang-Chul (Division of Cardiology, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Seung-Woo (Division of Cardiology, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Oh, Jae-K. (Division of Cardiology, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Published : 2010.12.27
⟨ Previous Next ⟩

Abstract

Background: Although there were studies about ethnic differences in aortic valve thickness and calcification that they may play a role in aortic valvular stenosis (AVS) progression, few studies about the progression rate of AVS in Asian population have been reported. The purpose of this study was to evaluate the progression rate of AVS in Korean patients. Methods: We retrospectively analyzed 325 patients (181 men, age: 67 ${\pm}$ 13 years) with AVS who had 2 or more echocardiograms at least 6 months apart from 2003 to 2008. The patients with other significant valvular diseases or history of cardiac surgery were excluded. The progression rate of AVS was expressed in terms of increase in maximum aortic jet velocity per year (meter/second/year). Results: Baseline AVS was mild in 207 (64%), moderate in 81 (25%), and severe in 37 (11%). There were no significant differences among the three groups in terms of age, gender, hypertension, smoking, and hypercholesterolemia. The mean progression rate was 0.12 ${\pm}$ 0.23 m/s/yr and more rapid in severe AVS (0.28 ${\pm}$ 0.36 m/s/yr) when compared to moderate (0.14 ${\pm}$ 0.26 m/s/yr) and mild AVS (0.09 ${\pm}$ 0.18 m/s/yr) (p < 0.001). The progression rate in bicuspid AVS was significantly higher than other AVS (0.23 ${\pm}$ 0.35 vs. 0.11 ${\pm}$ 0.20 m/s/yr, p = 0.002). By multivariate analysis, initial maximum aortic jet velocity (Beta = 0.175, p = 0.003), bicuspid aortic valve (Beta = 0.127, p = 0.029), and E velocity (Beta = -0.134, p = 0.018) were significantly associated with AVS progression. Conclusion: The progression rate of AVS in Korean patients is slower than that reported in Western population. Therefore, ethnic difference should be considered for the follow-up of the patients with AVS.

Keywords

References

  1. Otto CM, Burwash IG, Legget ME, Munt BI, Fujioka M, Healy NL, Kraft CD, Miyake-Hull CY, Schwaegler RG. Prospective study of asymptomatic valvular aortic stenosis. Clinical, echocardiographic, and exercise predictors of outcome. Circulation 1997;95:2262-70. https://doi.org/10.1161/01.CIR.95.9.2262
  2. Otto CM, Pearlman AS, Gardner CL. Hemodynamic progression of aortic stenosis in adults assessed by Doppler echocardiography. J Am Coll Cardiol 1989;13:545-50. https://doi.org/10.1016/0735-1097(89)90590-1
  3. Rosenhek R, Binder T, Porenta G, Lang I, Christ G, Schemper M, Maurer G, Baumgartner H. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med 2000;343:611-7. https://doi.org/10.1056/NEJM200008313430903
  4. Rosenhek R, Klaar U, Schemper M, Scholten C, Heger M, Gabriel H, Binder T, Maurer G, Baumgartner H. Mild and moderate aortic stenosis. Natural history and risk stratification by echocardiography. Eur Heart J 2004;25:199-205. https://doi.org/10.1016/j.ehj.2003.12.002
  5. Bahler RC, Desser DR, Finkelhor RS, Brener SJ, Youssefi M. Factors leading to progression of valvular aortic stenosis. Am J Cardiol 1999;84: 1044-8. https://doi.org/10.1016/S0002-9149(99)00496-8
  6. Peter M, Hoffmann A, Parker C, Lüscher T, Burckhardt D. Progression of aortic stenosis. Role of age and concomitant coronary artery disease. Chest 1993;103:1715-9. https://doi.org/10.1378/chest.103.6.1715
  7. Sashida Y, Rodriguez CJ, Boden-Albala B, Jin Z, Elkind MS, Liu R, Rundek T, Sacco RL, DiTullio MR, Homma S. Ethnic differences in aortic valve thickness and related clinical factors. Am Heart J 2010; 159:698-704. https://doi.org/10.1016/j.ahj.2009.12.031
  8. Nasir K, Katz R, Takasu J, Shavelle DM, Detrano R, Lima JA, Blumenthal RS, O'Brien K, Budoff MJ. Ethnic differences between extra-coronary measures on cardiac computed tomography: multi-ethnic study of atherosclerosis (MESA). Atherosclerosis 2008;198:104-14. https://doi.org/10.1016/j.atherosclerosis.2007.09.008
  9. Park JC, Kim W, Kim JH, Park WS, Park OY, Ahn YK, Jeong MH, Cho JG, Oh BS, Ahn BH, Kim SH, JC K. Prognostic factors for medically treated patients with valvular aortic stenosis. Chonnam Med J 2003;39:29-36.
  10. Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, Iung B, Otto CM, Pellikka PA, Quinones M; American Society of Echocardiography; European Association of Echocardiography. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr 2009;22:1-23; quiz 101-2. https://doi.org/10.1016/j.echo.2008.11.029
  11. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986;57:450-8. https://doi.org/10.1016/0002-9149(86)90771-X
  12. Oh JK, Taliercio CP, Holmes DR Jr, Reeder GS, Bailey KR, Seward JB, Tajik AJ. Prediction of the severity of aortic stenosis by Doppler aortic valve area determination: prospective Doppler-catheterization correlation in 100 patients. J Am Coll Cardiol 1988;11:1227-34. https://doi.org/10.1016/0735-1097(88)90286-0
  13. Kume T, Kawamoto T, Okura H, Watanabe N, Toyota E, Neishi Y, Okahashi N, Yamada R, Yoshida K. Rapid progression of mild to moderate aortic stenosis in patients older than 80 years. J Am Soc Echocardiogr 2007;20:1243-6. https://doi.org/10.1016/j.echo.2007.03.022
  14. Palta S, Pai AM, Gill KS, Pai RG. New insights into the progression of aortic stenosis: implications for secondary prevention. Circulation 2000; 101:2497-502. https://doi.org/10.1161/01.CIR.101.21.2497
  15. Edwards JE. The congenital bicuspid aortic valve. Circulation 1961;23: 485-8.
  16. Villari B, Hess OM, Kaufmann P, Krogmann ON, Grimm J, Krayenbuehl HP. Effect of aortic valve stenosis (pressure overload) and regurgitation (volume overload) on left ventricular systolic and diastolic function. Am J Cardiol 1992;69:927-34. https://doi.org/10.1016/0002-9149(92)90795-Z

Cited by

  1. Implementation of diagnosis in asymptomatic patients with aortic stenosis : the Implementation of Diagnosis in asymptomatic patiEnts with Aortic Stenosis registry vol.16, pp.4, 2010, https://doi.org/10.2459/jcm.0000000000000021
  2. Effect of bicuspid aortic valve phenotype on progression of aortic stenosis vol.21, pp.7, 2010, https://doi.org/10.1093/ehjci/jeaa068
  3. Progression of aortic stenosis with bicuspid aortic valves: evidence and intuition vol.21, pp.7, 2010, https://doi.org/10.1093/ehjci/jeaa141
  4. Higher rate of aortic stenosis progression in patients with bicuspid versus tricuspid aortic valve - A single center experience vol.66, pp.2, 2021, https://doi.org/10.1016/j.advms.2021.07.004
  5. Progression of aortic stenosis in patients with bicuspid aortic valve vol.36, pp.12, 2010, https://doi.org/10.1111/jocs.16026
  6. Bicuspid aortic valve: Progression of stenosis and clinical relevance vol.36, pp.12, 2021, https://doi.org/10.1111/jocs.16029