[Natural history of chronic aortic valve. Significance of hemodynamic findings (author's transl)].

The natural history of chronic aortic valve disease is well known from non-invasive data, but invasive data documenting the natural course of this disease are lacking. We studied hemodynamic data of 45 patients who had chronic aortic valve disease and were in functional class III or IV. All patients were candidates for prosthetic aortic valve replacement, but refused operation. These patients document the natural course of aortic valve disease. Invasive hemodynamic data were obtained by heart catheterization. Patients with aortic stenosis who died during the observation period had a transvalve gradient of 83 +/- 40 mm Hg, which was comparable to the gradient of survivors (70 +/- 16 mm Hg, p greater than 0.05), but left ventricular end-diastolic pressure, mean left atrial pressure and pulmonary artery pressure were higher indicating impaired left ventricular function. Patients with aortic stenosis who were repeatedly studied with heart catheterization (n = 7, average interval between studies 3.3 years) showed a significant increase of left ventricular filling pressure and of pulmonary arteriolar resistance and a fall of cardiac index. Patients with aortic insufficiency who died during the observation period had higher left ventricular filling pressures than survivors. Patients with aortic insufficiency who were repeatedly studied with heart catheterization (n = 5, average interval 2.9 years) showed no change of hemodynamic parameters. The latter group showed symptomatic deterioration although hemodynamics were unchanged. We conclude, in chronic aortic valve disease hemodynamic parameters regarding left ventricular function have prognostic implications.