Echocardiographic Progression of Calcific Aortic Valve Disease in Patients with Preexisting Aortic Valve Sclerosis

Objective We aimed to evaluate echocardiographic parameters to predict CAVD progression. Background Calcific aortic valve disease (CAVD) ranges from aortic valve sclerosis (ASc) with no functional impairment of the aortic valve to severe aortic stenosis (AS). It remains uncertain, which patients with ASc are at particular high risk of developing AS. Methods We included a total of 153 patients with visual signs of ASc and peak flow velocity (Vmax.) below 2.5m/s at baseline echocardiography. Progression of CAVD to AS was defined as an increase of the Vmax. >= 2.5m/s with a delta of >= 0.1m/s; stable ASc complied with a Vmax. below 2.5m/s and a delta < 0.1m/s. Finally, we compared clinical and echocardiographic parameters between these two groups. Results The mean age at baseline was 73.5 (+- 8.2) years and 66.7% were of male gender. After a mean follow-up of 1463 days, 57 patients developed AS, while 96 patients remained in the ASc group. The AS group showed significantly more calcification (p < 0.001) and thickening (p < 0.001) of the aortic valve cusps at baseline, although hemodynamics showed no evidence of AS in both groups (ASc group: Vmax. 1.6 +- 0.3 m/s versus AS group: Vmax. 1.9 +- 0.3 m/s; p < 0.001). Advanced calcification (OR (95% CI): 4.8 (1.5-15.9); p = 0.009) and a cusp thickness > 0.26cm (OR (95% CI): 16.6 (5.4-50.7); p < 0.001) were independent predictors for the development of AS. Conclusion The acquisition of simple echocardiographic parameter may help to identify patients at particular high risk of developing AS.