di Santis Matteo, Khalil Zeyad Hossam Atta, Wei-Liang Chen, Mouhamed Hesham, Whitmore Samuel J, Novak Amira L, Al-Mansouri Fatima, Mendieta Rafael O
Research Department (part-time), October 6th University, October City, Egypt.
College of Medicine, October 6th University, October City, Giza, Cairo, Egypt.
High Blood Press Cardiovasc Prev. 2025 Jun 9. doi: 10.1007/s40292-025-00723-y.
Moderate aortic stenosis (AS) has traditionally been considered a stable condition, but recent evidence suggests that some patients progress rapidly to severe AS, leading to earlier symptom onset and worse outcomes. Current guidelines primarily focus on severe AS, leaving a gap in risk stratification for moderate cases. This study aims to identify echocardiographic and clinical predictors of rapid progression in moderate AS to refine patient selection for closer monitoring and early intervention.
To identify clinical, echocardiographic, and imaging predictors of progression in moderate aortic stenosis, with particular focus on diastolic function, ΔV/Δt, myocardial fibrosis, and the impact of comorbidities and medical therapy on disease trajectory.
This prospective, multi-center cohort study enrolled 650 patients with moderate AS (AVA 1.0-1.5 cm, mean gradient 20-39 mmHg) across 10 cardiovascular centers in the Middle East between Egypt, Jordan, and Tunisia (2021-2024). Patients with prior valve interventions, severe comorbidities, or poor echocardiographic windows were excluded. Transthoracic echocardiography was performed at baseline and every six months to assess GLS, peak aortic jet velocity acceleration (ΔV/Δt), diastolic dysfunction, and aortic calcification (Agatston score in 300 patients). NT-proBNP and hs-Troponin T were measured at baseline and follow-up. Moreover, a pre-specified sub-study investigated the association between specific genetic polymorphisms and medication response in a subset of 87 patients.
At 24 months, 31% of patients exhibited rapid AS progression. Independent predictors included GLS > - 16% (OR 3.2, p < 0.001), ΔV/Δt > 350 cm/s (OR 2.8, p = 0.003), Agatston score > 2000 (HR 4.1, p < 0.001), E/e' > 15 (HR 2.3, p = 0.02), and NT-proBNP > 900 pg/mL (HR 3.0, p = 0.001). Patients with ≥ 3 risk factors had an 8-fold increased risk of rapid progression.
These findings provide novel evidence that GLS impairment, ΔV/Δt, aortic calcification burden, and diastolic dysfunction independently predict rapid AS progression. This supports the need for earlier echocardiographic surveillance and risk-based decision-making in moderate AS.
中度主动脉瓣狭窄（AS）传统上被认为是一种稳定的病症，但最近的证据表明，一些患者会迅速进展为重度AS，导致症状更早出现且预后更差。当前指南主要关注重度AS，在中度病例的风险分层方面存在空白。本研究旨在确定中度AS快速进展的超声心动图和临床预测因素，以优化患者选择，进行更密切的监测和早期干预。
确定中度主动脉瓣狭窄进展的临床、超声心动图和影像学预测因素，特别关注舒张功能、ΔV/Δt、心肌纤维化以及合并症和药物治疗对疾病轨迹的影响。
这项前瞻性、多中心队列研究纳入了中东地区埃及、约旦和突尼斯10个心血管中心的650例中度AS患者（主动脉瓣面积[AVA]1.0 - 1.5平方厘米，平均压力阶差20 - 39毫米汞柱）（2021 - 2024年）。排除曾接受瓣膜干预、有严重合并症或超声心动图窗不佳的患者。在基线和每六个月进行经胸超声心动图检查，以评估左室纵向应变（GLS）、主动脉峰值射流速度加速度（ΔV/Δt）、舒张功能障碍和主动脉钙化（300例患者采用阿加西顿积分）。在基线和随访时测量N末端B型利钠肽原（NT-proBNP）和高敏肌钙蛋白T。此外，一项预先指定的子研究在87例患者的子集中调查了特定基因多态性与药物反应之间的关联。
在24个月时，31%的患者出现AS快速进展。独立预测因素包括GLS > - 16%（比值比[OR]3.2，p < 0.001）、ΔV/Δt > 350厘米/秒（OR 2.8，p = 0.003）、阿加西顿积分> 2000（风险比[HR]4.1，p < 0.001）、E/e' > 15（HR 2.3，p = 0.02）以及NT-proBNP > 900皮克/毫升（HR 3.0，p = 0.001）。具有≥3个风险因素的患者快速进展风险增加8倍。
这些发现提供了新的证据，表明GLS受损、ΔV/Δt、主动脉钙化负担和舒张功能障碍独立预测AS快速进展。这支持了在中度AS中需要更早进行超声心动图监测和基于风险的决策。
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