Initial changes in peak aortic jet velocity and mean gradient predict progression to severe aortic stenosis
Background: There is significant interindividual variability in the rate of aortic stenosis (AS) progression that is not accounted for in the current surveillance algorithms. We sought to examine the association between changes in peak aortic jet velocity (Vmax) and mean gradient (MG) among patients...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2020-10-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906720302906 |
| _version_ | 1818403597937803264 |
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| author | Arash Nayeri Meng Xu Eric Farber-Eger Marcia Blair Inderpreet Saini Kamran Shamsa Gregg Fonarow Tamara Horwich Quinn S. Wells |
| author_facet | Arash Nayeri Meng Xu Eric Farber-Eger Marcia Blair Inderpreet Saini Kamran Shamsa Gregg Fonarow Tamara Horwich Quinn S. Wells |
| author_sort | Arash Nayeri |
| collection | DOAJ |
| description | Background: There is significant interindividual variability in the rate of aortic stenosis (AS) progression that is not accounted for in the current surveillance algorithms. We sought to examine the association between changes in peak aortic jet velocity (Vmax) and mean gradient (MG) among patients with mild or moderate AS and risk of progression to severe disease. Methods: Adult subjects referred for echocardiography at a single academic referral center with a diagnosis of mild or moderate AS and ≥2 additional surveillance echocardiograms were included in the study. Changes in Vmax and MG between the first two echocardiograms were indexed to time and tested for association with future progression to severe AS. Results: Among three hundred and sixty-four subjects, the median time between first and second echocardiograms was 1.3 years and initial changes in Vmax and MG indexed to time were +0.16 m/s per year and +1.44 mmHg per year, respectively. Fifty-three (15%) and fifty-six (15%) subjects progressed to severe AS defined by Vmax and MG, respectively. In multivariable logistic regression, initial increase in Vmax (OR = 4.19, 95% CI 1.93–9.10, p < 0.001) and initial increase in MG (OR = 1.12, 95% CI 1.06–1.18, p < 0.001) were associated with progression to severe AS. Conclusions: Initial changes in Vmax and MG among patients with mild or moderate AS are strongly associated with risk of progression to severe AS and may help guide individualized surveillance strategies. |
| first_indexed | 2024-12-14T08:26:48Z |
| format | Article |
| id | doaj.art-3e1dfd949be74a6a92e774069ef18b40 |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-12-14T08:26:48Z |
| publishDate | 2020-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-3e1dfd949be74a6a92e774069ef18b402022-12-21T23:09:38ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672020-10-0130100592Initial changes in peak aortic jet velocity and mean gradient predict progression to severe aortic stenosisArash Nayeri0Meng Xu1Eric Farber-Eger2Marcia Blair3Inderpreet Saini4Kamran Shamsa5Gregg Fonarow6Tamara Horwich7Quinn S. Wells8University of California, Los Angeles, CA, United States; Corresponding author at: University of California, Los Angeles, Department of Cardiovascular Medicine, 757 Westwood Plaza, St. 7501, Los Angeles, CA 90095-7417, United States.Vanderbilt University Medical Center, Nashville, TN, United StatesVanderbilt University Medical Center, Nashville, TN, United States; Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Nashville, TN, United StatesVanderbilt University Medical Center, Nashville, TN, United States; Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Nashville, TN, United StatesUniversity of California, Los Angeles, CA, United StatesUniversity of California, Los Angeles, CA, United StatesUniversity of California, Los Angeles, CA, United StatesUniversity of California, Los Angeles, CA, United StatesVanderbilt University Medical Center, Nashville, TN, United States; Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Nashville, TN, United StatesBackground: There is significant interindividual variability in the rate of aortic stenosis (AS) progression that is not accounted for in the current surveillance algorithms. We sought to examine the association between changes in peak aortic jet velocity (Vmax) and mean gradient (MG) among patients with mild or moderate AS and risk of progression to severe disease. Methods: Adult subjects referred for echocardiography at a single academic referral center with a diagnosis of mild or moderate AS and ≥2 additional surveillance echocardiograms were included in the study. Changes in Vmax and MG between the first two echocardiograms were indexed to time and tested for association with future progression to severe AS. Results: Among three hundred and sixty-four subjects, the median time between first and second echocardiograms was 1.3 years and initial changes in Vmax and MG indexed to time were +0.16 m/s per year and +1.44 mmHg per year, respectively. Fifty-three (15%) and fifty-six (15%) subjects progressed to severe AS defined by Vmax and MG, respectively. In multivariable logistic regression, initial increase in Vmax (OR = 4.19, 95% CI 1.93–9.10, p < 0.001) and initial increase in MG (OR = 1.12, 95% CI 1.06–1.18, p < 0.001) were associated with progression to severe AS. Conclusions: Initial changes in Vmax and MG among patients with mild or moderate AS are strongly associated with risk of progression to severe AS and may help guide individualized surveillance strategies.http://www.sciencedirect.com/science/article/pii/S2352906720302906Aortic stenosisProgressionEchocardiographyPeak aortic jet velocity (Vmax)Mean gradient (MG) |
| spellingShingle | Arash Nayeri Meng Xu Eric Farber-Eger Marcia Blair Inderpreet Saini Kamran Shamsa Gregg Fonarow Tamara Horwich Quinn S. Wells Initial changes in peak aortic jet velocity and mean gradient predict progression to severe aortic stenosis International Journal of Cardiology: Heart & Vasculature Aortic stenosis Progression Echocardiography Peak aortic jet velocity (Vmax) Mean gradient (MG) |
| title | Initial changes in peak aortic jet velocity and mean gradient predict progression to severe aortic stenosis |
| title_full | Initial changes in peak aortic jet velocity and mean gradient predict progression to severe aortic stenosis |
| title_fullStr | Initial changes in peak aortic jet velocity and mean gradient predict progression to severe aortic stenosis |
| title_full_unstemmed | Initial changes in peak aortic jet velocity and mean gradient predict progression to severe aortic stenosis |
| title_short | Initial changes in peak aortic jet velocity and mean gradient predict progression to severe aortic stenosis |
| title_sort | initial changes in peak aortic jet velocity and mean gradient predict progression to severe aortic stenosis |
| topic | Aortic stenosis Progression Echocardiography Peak aortic jet velocity (Vmax) Mean gradient (MG) |
| url | http://www.sciencedirect.com/science/article/pii/S2352906720302906 |
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