Aortic Stenosis Progression and Outcomes: Key Findings from a Multicenter Registry

Introduction:
AS progression rates vary significantly among individuals, impacting prognosis. Factors driving this progression are poorly understood, and no therapies effectively slow it. Limited studies explore AS progression`s impact on outcomes. This study aimed to identify risk factors for AS progression and its association with outcomes using a multicenter registry.

Methods:
From 2006–2021, 11,000 patients with mild-to-severe AS underwent echocardiography at Kaplan Medical Center. Another 15,355 patients were included from the Clalit HMO database. Of these, 5,008 had >2 echocardiograms ≥6 months apart. Patients were categorized into Slow and Fast progression groups based on median peak gradient progression (3.8 mmHg/year; range: 1.3–8). Clinical, lab, and echocardiographic data were analyzed via univariate and multivariate models. Outcomes included all-cause mortality and a composite of mortality and AVR.

Results:
The cohort (mean age: 74±11 years, 52% male) included 2,131 with mild AS, 2,211 with moderate AS, and 666 with severe AS. Faster progression correlated with higher baseline AS severity (mean/peak gradient, valve area), LV dimensions (ED/ES diameters), LV function, and LA size (p<0.05). Age, gender, and cholesterol levels showed no association (p>0.05). Over a median follow-up of 1,919 days, 2,142 patients died, and 855 underwent AVR. Progression significantly predicted mortality (HR: 1.062, 95% CI: 1.026–1.099, p<0.001, figure) and the composite outcome (HR: 1.069, 95% CI: 1.045–1.094, p<0.001).

Conclusion:
AS progression is strongly linked to baseline AS severity, LV size, and function, but not age or gender. It significantly predicts mortality and interventions, underscoring the need for its integration into management strategies.