title: Haemodynamic and anatomic progression of aortic stenosis.
abstract: BACKGROUND
  Aortic valve stenosis (AS) is a progressive disease, but the impact of baseline AS haemodynamic or anatomic severity on AS progression remains unclear.
  
  
  METHODS
  In 149 patients (104 mild AS, 36 moderate AS and 9 severe AS) enrolled in 2 ongoing prospective cohorts (COFRASA/GENERAC), we evaluated AS haemodynamic severity at baseline and yearly, thereafter, using echocardiography (mean pressure gradient (MPG)) and AS anatomic severity using CT (degree of aortic valve calcification (AVC)).
  
  
  RESULTS
  After a mean follow-up of 2.9±1.0 years, mean MGP increased from 22±11 to 30±16 mm Hg (+3±3 mm Hg/year), and mean AVC from 1108±891 to 1640±1251 AU (arbitrary units) (+188±176 AU/year). Progression of AS was strongly related to baseline haemodynamic severity (+2±3 mm Hg/year in mild AS, +4±3 mm Hg/year in moderate AS and +5±5 mm Hg/year in severe AS (p=0.01)), and baseline haemodynamic severity was an independent predictor of haemodynamic progression (p=0.0003). Annualised haemodynamic and anatomic progression rates were significantly correlated (r=0.55, p<0.0001), but AVC progression rate was also significantly associated with baseline haemodynamic severity (+141±133 AU/year in mild AS, +279±189 AU/year in moderate AS and +361±293 AU/year in severe AS, p<0.0001), and both baseline MPG and baseline AVC were independent determinants of AVC progression (p<0.0001).
  
  
  CONCLUSIONS
  AS progressed faster with increasing haemodynamic or anatomic severity. Our results suggest that a medical strategy aimed at preventing AVC progression may be useful in all subsets of patients with AS including those with severe AS and support the recommended closer follow-up of patients with AS as AS severity increases.
  
  
  BACKGROUND
  COFRASA (clinicalTrial.gov number NCT 00338676) and GENERAC (clinicalTrial.gov number NCT00647088).
authors: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France INSERM U698, Bichat Hospital, Paris, France University Paris 7, Paris, France.
authors: Virginia
authors: V
authors: Nguyen
authors: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France INSERM U698, Bichat Hospital, Paris, France.
authors: Claire
authors: C
authors: Cimadevilla
authors: Department of Epidemiology, Biostatistic and Clinical research, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors: Candice
authors: C
authors: Estellat
authors: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors: Isabelle
authors: I
authors: Codogno
authors: Centre de Ressources Biologique, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors: Virginie
authors: V
authors: Huart
authors: Centre de Ressources Biologique, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors: Joelle
authors: J
authors: Benessiano
authors: Centre d'Investigation Clinique 007, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors: Xavier
authors: X
authors: Duval
authors: Department of Medicine, Québec Heart and Lung Institute, Laval University, Québec city, Québec, Canada.
authors: Philippe
authors: P
authors: Pibarot
authors: Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA.
authors: Marie Annick
authors: MA
authors: Clavel
authors: Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA.
authors: Maurice
authors: M
authors: Enriquez-Sarano
authors: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France INSERM U698, Bichat Hospital, Paris, France University Paris 7, Paris, France.
authors: Alec
authors: A
authors: Vahanian
authors: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France INSERM U698, Bichat Hospital, Paris, France University Paris 7, Paris, France.
authors: David
authors: D
authors: Messika-Zeitoun
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000473:pathology; D001024:Aortic Valve Stenosis / Q000473:pathology* / Q000503:physiopathology*; D001794:Blood Pressure; D002114:Calcinosis; D018450:Disease Progression; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed