title: Natural progression of low-gradient severe aortic stenosis with preserved ejection fraction.
abstract: Because the natural progression of low-gradient aortic stenosis (LGAS) has not been well defined, we performed a retrospective study of 116 consecutive patients with aortic stenosis who had undergone follow-up echocardiography at a median interval of 698 days (range, 371-1,020 d). All patients had preserved left ventricular ejection fraction (>0.50) during and after follow-up. At baseline, patients were classified by aortic valve area (AVA) as having mild stenosis (≥1.5 cm(2)), moderate stenosis (≥1 to <1.5 cm(2)), or severe stenosis (<1 cm(2)). Severe aortic stenosis was further classified by mean gradient (LGAS, mean <40 mmHg; high-gradient aortic stenosis [HGAS], mean ≥40 mmHg). We compared baseline and follow-up values among 4 groups: patients with mild stenosis, moderate stenosis, LGAS, and HGAS. At baseline, 30 patients had mild stenosis, 54 had moderate stenosis, 24 had LGAS, and 8 had HGAS. Compared with the moderate group, the LGAS group had lower AVA but similar mean gradient. Yet the actuarial curves for progressing to HGAS were significantly different: 25% of patients in LGAS reached HGAS status significantly earlier than did 25% of patients in the moderate-AS group (713 vs 881 d; P=0.035). Because LGAS has a high propensity to progress to HGAS, we propose that low-gradient aortic stenosis patients be closely monitored as a distinct subgroup that warrants more frequent echocardiographic follow-up.
authors: Cardiovascular Division (Drs. Innasimuthu, Kumar, and Lazar), State University of New York-Downstate Medical Center, Brooklyn, New York 11203; and Cardiovascular Institute (Dr. Katz), Scaife Hall, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213.
authors: Antony Leslie
authors: AL
authors: Innasimuthu
authors: Cardiovascular Division (Drs. Innasimuthu, Kumar, and Lazar), State University of New York-Downstate Medical Center, Brooklyn, New York 11203; and Cardiovascular Institute (Dr. Katz), Scaife Hall, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213.
authors: Sanjay
authors: S
authors: Kumar
authors: Cardiovascular Division (Drs. Innasimuthu, Kumar, and Lazar), State University of New York-Downstate Medical Center, Brooklyn, New York 11203; and Cardiovascular Institute (Dr. Katz), Scaife Hall, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213.
authors: Jason
authors: J
authors: Lazar
authors: Cardiovascular Division (Drs. Innasimuthu, Kumar, and Lazar), State University of New York-Downstate Medical Center, Brooklyn, New York 11203; and Cardiovascular Institute (Dr. Katz), Scaife Hall, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213.
authors: William E
authors: WE
authors: Katz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D014463:Ultrasonography; D016277:Ventricular Function, Left
keywords: Aortic valve stenosis; blood flow velocity; calcinosis/complications; disease progression; echocardiography; forecasting; prognosis; retrospective studies; risk assessment; stroke volume; time factors; ventricular function, left