Prognostic Factors for Medically Treated Patients with Valvular Aortic Stenosis

Sim, Doo Sun; Park, Jong Chun; Kim, Weon; Kim, Ju Han; Park, Woo Suk; Park, Ok Young; Ahn, Young Keun; Jeong, Myung Ho; Cho, Jeong Gwan; Oh, Bong Suk; Kim, Jae Ha; Ahn, Byoung Hee; Kim, Sang Hyung; Kang, Jung Chaee

Abstract

Valvular aortic stenosis is an active disease that progresses over time. The author sought to find out prognostic factors for the progression of aortic stenosis through clinical information and serial hemodynamic assessment with Doppler echocardiography. Ninety patients (63 +/- 11.7 years of age) diagnosed as valvular aortic stenosis at the Chonnam National University Hospital between 1990 and 2000 were analyzed on clinical symptoms and electrocardiographic and serial echocardiographic findings for a period of 3.5 +/- 0.5 years. The patients were divided into two groups, the worsening and the stable group, based on the progression of their maximal aortic jet velocities. The end-point of the follow-up was either aortic valve replacement or death. In overall patients New York Heart Association (NYHA) class III-IV increased significantly from 17% at the initial study to 20% at follow-up (p < 0.001). Maximal aortic jet velocity measured 3.8 +/- 1.2 m/s at the initial study increated to 4.3 +/- 1.0 m/s at follow-up (p < 0.001). As to the end- point aortic valve replacement (47%) was significantly higher (p<0.005) and all cardiac deaths (2%) occurred in the worsening group. Maximal aortic jet velocity at follow-up was significantly higher in the worsening group (4.3 +/- 0.9 m/s versus 3.6 +/- 0.7 m/s, p<0.005). Multiple logistic regression analysis for prognostic factors of worsening aortic stenosis revealed that NYHA class, left ventricular ejection fraction (EF) and initial maximal aortic jet velocity did not influence the progression of the disease. Noninvasive Doppler echocardiography provides help in assessing the worsening of valvular aortic stenosis. Increasing maximal aortic jet velocity can be of value in determining the time of surgery in patients with aortic stenosis regardless of changes in their clinical symptoms or left ventricular EF.