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The Myocardial Impact of Rapid Progression of Aortic Stenosis
Session:
SESSÃO DE POSTERS 16 - DIAGNÓSTICO E PROGNÓSTICO NA ESTENOSE AÓRTICA
Speaker:
Francisca Martins Nunes
Congress:
CPC 2025
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.7 Valvular Heart Disease - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Francisca Martins Nunes; Rafael Teixeira; André Lobo; Francisco Sousa; Maria Leonor Moura; Marta Catarina Almeida; Francisco Sampaio; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Aptos,sans-serif"><strong>Background: </strong><span style="font-family:"Calibri",sans-serif">Aortic stenosis (AS) is one of the most prevalent valvular heart diseases in developed countries, driven primarily by degenerative fibrocalcific changes. This progressive condition affects not only the aortic valve but also the myocardium, ultimately leading to significant cardiac damage. AS is a potentially life-threatening disease, characterized by progressive narrowing of the aortic orifice and structural changes that often extend beyond the left ventricle. Notably, retrospective studies have highlighted that the extent of baseline extra-aortic cardiac damage does not necessarily correlate with the baseline hemodynamic severity of AS. This study aimed to evaluate the rate of AS progression and its impact on cardiac damage and survival.</span></span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Methods: </span></strong><span style="font-family:"Calibri",sans-serif">We retrospectively identified 914 patients (age 76 ± 8 years, 52% female, median follow-up time 6.8 years) with AS who had undergone more than one echocardiogram. Bayesian hierarchical nonlinear models were used to predict aortic peak velocity (APV) as a function of time and estimate individual AS acceleration rates. Patients were then clustered into rapid progressors and slow progressors using machine learning algorithms.</span></span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Results: </span></strong><span style="font-family:"Calibri",sans-serif">APV was best modeled by a logistic function of time. A total of 483 patients were clustered as rapid progressors (53%) and 431 as slow progressors (47%), with acceleration rate coefficients estimated at 0.14 ± 0.02 years?¹ and 0.09 ± 0.02 years?¹, respectively (p < 0.01). No association was found between progression rate and clinical variables. Compared with slow progressors, rapid progressors had significantly higher 5-year incidences of left ventricular damage, combined left atrium and mitral valve damage, and combined tricuspid valve damage with pulmonary hypertension (all p ≤ 0.01). No statistically significant differences were seen in right ventricular damage between the groups due to the low number of events. After multivariate adjustment for age, gender, comorbidities, and baseline AS severity, rapid progression remained an independent predictor for all extra-aortic cardiac damages except right ventricular dysfunction. Importantly, baseline AS severity was not predictive of AS-related cardiac damage. Rapid progression was associated with higher mortality (HR 1.28, p = 0.02), persisting after adjustment for demographics, comorbidities, AS severity, and time-dependent aortic valve replacement (HR 1.36, p < 0.01).</span></span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Calibri",sans-serif">Conclusions: </span></strong><span style="font-family:"Calibri",sans-serif">The rapid progression of AS is a critical determinant of premature cardiac damage and reduced survival, independent of baseline disease severity. These findings highlight the importance of identifying and monitoring patients with rapidly progressing AS to enable timely interventions and possibly improve clinical outcomes.</span></span></span></p>
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