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Title: Progression of aortic stenosis in elderly patients over long-term follow up.
Austin Authors: Kearney, Leighton G ;Ord, M;Buxton, Brian F ;Matalanis, George ;Patel, Sheila K ;Burrell, Louise M ;Srivastava, Piyush M 
Affiliation: Department of Cardiology, Austin Health, VIC, Australia
Issue Date: 5-Apr-2012
Publication information: International Journal of Cardiology 2012; 167(4): 1226-31
Abstract: The natural history of aortic stenosis (AS) in elderly patients remains poorly defined. In an elderly cohort over long-term follow-up, we assessed: 1) rates and predictors of hemodynamic progression and 2) composite aortic valve replacement (AVR) or death endpoint.Consecutive Department of Veterans' Affairs patients with AS (>60 years) were prospectively enrolled between 1988 and 1994 (n=239) and followed until 2008. Patients with ≥ 2 trans-thoracic echocardiograms >6 months apart were included in the progression analysis (n=147). Baseline demographics, comorbidities and echocardiography parameters were recorded. Follow-up was censored at AVR/death.The age of patients was 73 ± 6 years; 82% were male. Baseline AS severity was mild (67%), moderate (23%) and severe (10%). Follow-up was 6.5 ± 4 years (range: 1-17 years). Annualized mean aortic valve gradient progression rates were: mild AS 4 ± 4 mmHg/year; moderate AS 6 ± 5 mmHg/year and severe AS 10 ± 8 mmHg/year (p<0.001). Five-year event-free survival was 66 ± 5%, 23 ± 7% and 20 ± 10% for mild, moderate and severe AS respectively. Progression to severe AS occurred in 35% and 74% of patients with mild and moderate AS respectively. Independent predictors of rapid progression were: baseline AS severity (per grade) (OR 2.6, p=0.001), aortic valve calcification (per grade) (OR 2.1, p=0.01), severe renal impairment (OR 4.0, p=0.04) and anemia (OR 2.3, p=0.05).In elderly patients, hemodynamic progression of AS is predicted by AS severity, renal function, aortic valve calcification and history of anemia. These factors identify patients at high risk of rapid hemodynamic progression, for whom more frequent clinical and echocardiographic surveillance is advisable.
Gov't Doc #: 22483251
DOI: 10.1016/j.ijcard.2012.03.139
Journal: International journal of cardiology
Type: Journal Article
Subjects: Aortic stenosis
Renal failure
Aged, 80 and over
Aortic Valve Stenosis.diagnosis.mortality
Cohort Studies
Disease Progression
Follow-Up Studies
Middle Aged
Prospective Studies
Survival Rate.trends
Appears in Collections:Journal articles

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