title: Predictors of Rapid Progression and Clinical Outcome of Asymptomatic Severe Aortic Stenosis.
abstract: BACKGROUND
  The optimal timing of aortic valve replacement (AVR) is controversial in patients with asymptomatic severe aortic stenosis (AS) except when very severe. Prediction of progression of severe AS is helpful in deciding on the timing of AVR. The purpose of this study was to clarify the predictors of progression rate and clinical outcomes of severe AS.
  
  
  RESULTS
  We retrospectively investigated 140 consecutive patients with asymptomatic severe AS (aortic valve area [AVA], 0.75-1.0 cm(2)). First-year progression rate and annual progression rate of AVA and of aortic jet velocity (AV-Vel) were calculated. Cardiac events were examined and the predictors of rapid progression and cardiac events were analyzed. The median follow-up period was 36 months. The median annual progression rate was -0.05 cm(2)/year for AVA and 0.22 m/s/year for AV-Vel. Dyslipidemia, moderate-severe calcification, and first-year AV-Vel progression ≥0.22 m/s/year were independent predictors of cardiac events. Cardiac event-free rate was lower in patients with AV-Vel first-year progression rate ≥0.22 m/s/year than in those with a lower rate. Diabetes and moderate-severe calcification were related to first-year rapid progression.
  
  
  CONCLUSIONS
  The annual progression rate of severe AS was -0.05 cm(2)/year for AVA and 0.22 m/s/year for AV-Vel. Patients with first-year rapid progression or severely calcified aortic valve should be carefully observed while considering an early operation. (Circ J 2016; 80: 1863-1869).
authors.affiliation: Department of Cardiology, Tenri Hospital.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Nishimura
authors.forename: Chisato
authors.initials: C
authors.lastname: Izumi
authors.forename: Masataka
authors.initials: M
authors.lastname: Nishiga
authors.forename: Masashi
authors.initials: M
authors.lastname: Amano
authors.forename: Sari
authors.initials: S
authors.lastname: Imamura
authors.forename: Naoaki
authors.initials: N
authors.lastname: Onishi
authors.forename: Yodo
authors.initials: Y
authors.lastname: Tamaki
authors.forename: Soichiro
authors.initials: S
authors.lastname: Enomoto
authors.forename: Makoto
authors.initials: M
authors.lastname: Miyake
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Tamura
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kondo
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Kaitani
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000097:blood* / Q000453:epidemiology / Q000503:physiopathology*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies