Progression of aortic stenosis in the elderly detected by noninvasive methods.

One hundred eighty consecutive male patients, mean age of 64.6 years, who were referred to cardiac catheterization for the evaluation of aortic stenosis (AS), were studied using a noninvasive scoring system. The system is based upon 7 variables including: 1) LVH by ECG, 2) aortic valve calcium by chest x-ray, 3) loudness of A2, 4) Q to peak of murmur, 5) T time of the carotid pulse, 6) LV ejection time and 7) LVH by echocardiography. The scoring system has a range from 0 to 16, and a score greater than or equal to 5 indicates severe AS (valve area less than or equal to 1.0 cm2). Eighteen patients had hemodynamic studies on two occasions. In 3 years progression of stenosis was evident by an increase in the mean aortic valve gradient from 23 +/- 3.4 mmHg to 44 +/- 4.2 mmHg (p less than 0.005). The aortic valve area decreased from 1.4 +/- 0.1 cm2 to 0.76 +/- 0.07 cm2 (p less than 0.005). Noninvasive scores increased in these patients from 2.1 +/- 0.5 to 7.6 +/- 1.0 (p less than 0.005). Fifty-one patients had repeated noninvasive studies. Twenty-two patients, who had mild AS at the initial evaluation, attained a score of greater than or equal to 5 in 3 years, indicating probable progression to severe AS. The mean initial score was 2.3 +/- 0.4, and the score at the end of the mean follow-up period of 3 years was 8.0 +/- 0.6 (p less than 0.005).(ABSTRACT TRUNCATED AT 250 WORDS)