Progression of aortic stenosis in 394 patients: relation to changes in myocardial and mitral valve dysfunction
SJ Brener,
CI Duffy,
JD Thomas,
and
WJ Stewart
Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195.
OBJECTIVES. This study reports the results of echocardiographic follow-up in a large cohort of patients with aortic stenosis and correlates the progression of aortic stenosis with changes in the degree of mitral regurgitation and left ventricular hypertrophy and systolic dysfunction. BACKGROUND. Progressive aortic stenosis often causes left ventricular dysfunction and mitral regurgitation. Doppler echocardiography has greatly assisted in the noninvasive evaluation and follow-up of aortic stenosis. Nevertheless, the longitudinal follow-up of patients with Doppler echocardiography for the progression of aortic stenosis and the significance of progressive ventricular hypertrophy and mitral regurgitation have not been reported. METHODS. Serial Doppler echocardiography was performed in 394 consecutive patients with valvular aortic stenosis at baseline and after a mean follow-up period of 37 +/- 16 months. Mean and peak aortic gradients, aortic valve area, left ventricular systolic and diastolic diameters and percent area change (shortening fraction) were expressed as continuous variables, and systolic dysfunction, mitral regurgitation, ventricular hypertrophy and filling properties were tabulated as categoric variables using a semiquantitative grading system. RESULTS. Peak and mean gradients increased by an average of 8.3 and 6.3 mm Hg/year, respectively; end-systolic and end-diastolic diameters increased by 1.9 and 1.6 mm/year, respectively; and aortic valve area decreased by 0.14 cm2/year during the follow-up interval (p < 0.001 for all), indicating progression of aortic stenosis and ventricular dilation. Patients in the lowest quartile of aortic valve area and highest quartiles of mean and peak gradients had the least change compared with those in the highest quartile of aortic valve area and lowest quartile of mean and peak gradients (p < 0.01 for all). Patients with more mitral regurgitation at follow-up than at baseline had higher mean percent increase in mean and peak gradients as well as more progression of ventricular dilation and worsening systolic function compared with those with stable or improving mitral regurgitation (p < 0.05 for all). Similarly, subjects with worsening left ventricular hypertrophy had larger mean percent increase in mean and peak gradients than those with stable left ventricular hypertrophy (p < 0.01) but maintained stable ventricular volumes and systolic function. There was no correlation between the amount of change in mean or peak gradients and degree of deterioration in systolic function. CONCLUSIONS. Aortic stenosis progresses predictably over time; however, systolic dysfunction is an inconsistent marker of the hemodynamic consequences of severe aortic stenosis. As an adaptive response to pressure overload, progressive hypertrophy appears to prevent ventricular dilation and development or worsening of mitral regurgitation. Conversely, progressive mitral regurgitation may be seen as a maladaptive consequence of increasing aortic stenosis.
This article has been cited by other articles:
|
|
|
|
 
E. Angeloni, G. Melina, P. Pibarot, U. Benedetto, S. Refice, G. M. Ciavarella, A. Roscitano, R. Sinatra, and J. R. Pepper
Impact of Prosthesis-Patient Mismatch on the Regression of Secondary Mitral Regurgitation After Isolated Aortic Valve Replacement With a Bioprosthetic Valve in Patients With Severe Aortic Stenosis
Circ Cardiovasc Imaging,
January 1, 2012;
5(1):
36 - 42.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. S. Jeong, P. W. Park, K. Sung, W. S. Kim, J.-H. Yang, T.-G. Jun, and Y. T. Lee
Long-Term Clinical Impact of Functional Mitral Regurgitation After Aortic Valve Replacement
Ann. Thorac. Surg.,
October 1, 2011;
92(4):
1339 - 1345.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Unger, C. Dedobbeleer, G. Van Camp, D. Plein, B. Cosyns, and P. Lancellotti
Republished review: Mitral regurgitation in patients with aortic stenosis undergoing valve replacement
Postgrad. Med. J.,
February 1, 2011;
87(1024):
150 - 155.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. J. Vliek, E. Balaras, S. Li, J. Y. Lin, C. A. Young, C. R. DeFilippi, B. P. Griffith, and J. S. Gammie
Early and Midterm Hemodynamics After Aortic Valve Bypass (Apicoaortic Conduit) Surgery
Ann. Thorac. Surg.,
July 1, 2010;
90(1):
136 - 143.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P Unger, C Dedobbeleer, G Van Camp, D Plein, B Cosyns, and P Lancellotti
Mitral regurgitation in patients with aortic stenosis undergoing valve replacement
Heart,
January 1, 2010;
96(1):
9 - 14.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. P. Dal-Bianco, B. K. Khandheria, F. Mookadam, F. Gentile, and P. P. Sengupta
Management of Asymptomatic Severe Aortic Stenosis
J. Am. Coll. Cardiol.,
October 14, 2008;
52(16):
1279 - 1292.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al.
2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Circulation,
October 7, 2008;
118(15):
e523 - e661.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al.
2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
September 23, 2008;
52(13):
e1 - e142.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Enriquez-Sarano, V. T. Nkomo, and H. Michelena
Principles and Practice of Echocardiography in Cardiac Surgery
Card. Surg. Adult,
January 1, 2008;
3(2008):
315 - 348.
[Full Text]
|
|
|
|
|
|
|
T. Mihaljevic, M. R. Sayeed, S. C. Stamou, and S. Paul
Pathophysiology of Aortic Valve Disease
Card. Surg. Adult,
January 1, 2008;
3(2008):
825 - 840.
[Full Text]
|
|
|
|
|
|
|
F. Vanden Eynden, D. Bouchard, I. El-Hamamsy, A. Butnaru, P. Demers, M. Carrier, L. P. Perrault, J.-C. Tardif, and M. Pellerin
Effect of Aortic Valve Replacement for Aortic Stenosis on Severity of Mitral Regurgitation
Ann. Thorac. Surg.,
April 1, 2007;
83(4):
1279 - 1284.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al.
ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
August 1, 2006;
48(3):
e1 - e148.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al.
ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
August 1, 2006;
48(3):
598 - 675.
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Liu, C. A. Coursey, C. Grahame-Clarke, R. R. Sciacca, A. Rozenshtein, S. Homma, and J. H. M. Austin
Aortic Valve Calcification as an Incidental Finding at CT of the Elderly: Severity and Location as Predictors of Aortic Stenosis
Am. J. Roentgenol.,
February 1, 2006;
186(2):
342 - 349.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Kupari, H. Turto, and J. Lommi
Left ventricular hypertrophy in aortic valve stenosis: preventive or promotive of systolic dysfunction and heart failure?
Eur. Heart J.,
September 1, 2005;
26(17):
1790 - 1796.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. V. Freeman and C. M. Otto
Spectrum of Calcific Aortic Valve Disease: Pathogenesis, Disease Progression, and Treatment Strategies
Circulation,
June 21, 2005;
111(24):
3316 - 3326.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Rosenhek, F. Rader, N. Loho, H. Gabriel, M. Heger, U. Klaar, M. Schemper, T. Binder, G. Maurer, and H. Baumgartner
Statins but Not Angiotensin-Converting Enzyme Inhibitors Delay Progression of Aortic Stenosis
Circulation,
September 7, 2004;
110(10):
1291 - 1295.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Rosenhek, U. Klaar, M. Schemper, C. Scholten, M. Heger, H. Gabriel, T. Binder, G. Maurer, and H. Baumgartner
Mild and moderate aortic stenosis: Natural history and risk stratification by echocardiography
Eur. Heart J.,
February 1, 2004;
25(3):
199 - 205.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Piper, R. Bergemann, H. D. Schulte, R. Koerfer, and D. Horstkotte
Can progression of valvar aortic stenosis be predicted accurately?
Ann. Thorac. Surg.,
September 1, 2003;
76(3):
676 - 680.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Absil, F. Dagenais, P. Mathieu, J. Metras, J. Perron, R. Baillot, R. Bauset, and D. Doyle
Does moderate mitral regurgitation impact early or mid-term clinical outcome in patients undergoing isolated aortic valve replacement for aortic stenosis?
Eur J Cardiothorac Surg,
August 1, 2003;
24(2):
217 - 222.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. F. Bellamy, P. A. Pellikka, K. W. Klarich, A. J. Tajik, and M. Enriquez-Sarano
Association of cholesterol levels, hydroxymethylglutaryl coenzyme-a reductase inhibitor treatment, and progression of aortic stenosis in the community
J. Am. Coll. Cardiol.,
November 20, 2002;
40(10):
1723 - 1730.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. S. Pearlman
Medical treatment ofaortic stenosis: Promising, or wishful thinking?
J. Am. Coll. Cardiol.,
November 20, 2002;
40(10):
1731 - 1734.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. K. Choudhary, S. Talwar, R. Juneja, and A. S. Kumar
Fate of mild aortic valve disease after mitral valve intervention
J. Thorac. Cardiovasc. Surg.,
September 1, 2001;
122(3):
583 - 586.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S Takeda, H Rimington, N Smeeton, and J Chambers
Long axis excursion in aortic stenosis
Heart,
July 1, 2001;
86(1):
52 - 56.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Iung
VALVE DISEASE: Interface between valve disease and ischaemic heart disease
Heart,
September 1, 2000;
84(3):
347 - 352.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Palta, A. M. Pai, K. S. Gill, and R. G. Pai
New Insights Into the Progression of Aortic Stenosis : Implications for Secondary Prevention
Circulation,
May 30, 2000;
101(21):
2497 - 2502.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Enriquez-Sarano, A.-J. Basmadjian, A. Rossi, K. R. Bailey, J. B. Seward, and A. J. Tajik
Progression of mitral regurgitation: A prospective Doppler echocardiographic study
J. Am. Coll. Cardiol.,
October 1, 1999;
34(4):
1137 - 1144.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. M. Sundt III, S. F. Murphy, B. Barzilai, R. B. Schuessler, E. N. Mendeloff, C. B. Huddleston, M. K. Pasque, and W. A. Gay Jr
Previous Coronary Artery Bypass Grafting Is Not a Risk Factor for Aortic Valve Replacement
Ann. Thorac. Surg.,
September 1, 1997;
64(3):
651 - 657.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
C. M. Otto, I. G. Burwash, M. E. Legget, B. I. Munt, M. Fujioka, N. L. Healy, C. D. Kraft, C. Y. Miyake-Hull, and R. G. Schwaegler
Prospective Study of Asymptomatic Valvular Aortic Stenosis : Clinical, Echocardiographic, and Exercise Predictors of Outcome
Circulation,
May 6, 1997;
95(9):
2262 - 2270.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
J. A. Odell, C. J. Mullany, H. V. Schaff, T. A. Orszulak, R. C. Daly, and J. J. Morris
Aortic Valve Replacement After Previous Coronary Artery Bypass Grafting
Ann. Thorac. Surg.,
November 1, 1996;
62(5):
1424 - 1430.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
Echocardiographic Correlates of Aortic Stenosis Progression
Journal Watch Cardiology,
March 1, 1995;
1995(301):
9 - 9.
[Full Text]
|
|
|
|
|
|
|
HOW FAST DOES AORTIC STENOSIS PROGRESS?
Journal Watch (General),
February 21, 1995;
1995(221):
6 - 6.
[Full Text]
|
|
|
|
