Predictors of Echocardiographic Progression in Patients With Mild Aortic Stenosis

Background and Objectives: The factors related to the progression of mild aortic stenosis (AS) remain unknown. We wanted to evaluate the long-term outcomes and predictors of echocardiographic progression in patients with mild AS. Subjects and Methods: We prospectively included 103 consecutive asymptomatic patients (62.1${\pm}$11.9 years, 31 males) with mild AS. Mild AS was defined as aortic valve (AV) thickening accompanied by a peak aortic jet velocity (AV Vmax) $\geq$2.0 and <3.0 m/sec, and rapid progression of AS was defined as an average annual increase in the AV Vmax $\geq$0.2 m/sec, and cardiac events were defined as cardiac death or AV replacement. Results: During a median echocardiographic follow-up time of 6.0 years, the average change in the AV Vmax was 0.08${\pm}$0.10 m/sec per year. The rate of progression was significantly associated with age, moderate-to-severe AV calcification and the baseline AV Vmax, but not with the serum cholesterol level. The baseline AV Vmax (2.6${\pm}$0.3 m/sec vs. 2.2${\pm}$0.3 m/sec, respectively, p<0.001) and the incidence of moderate-to-severe AV calcification (92.9% vs. 36.5%, respectively, p<0.001) were significantly higher in the rapid progression group than in the slow progression group. The 7-year cardiac event-free survival rate was lower in the rapid progression group than in the slow pro-gression group (87.5${\pm}$8.3% vs. 100%, respectively). Conclusion: The progression of AS was slower than expected and it was re-lated to age, the baseline AV Vmax and AV calcification. Because of the marked individual variability in progression, the patients showing rapid progression of AS need closer follow-up.