Aortic valve sclerosis is not a benign finding but progressive disease associated with poor cardiovascular outcomes
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Background Aortic valve sclerosis (AVS) shares risk factors with atherosclerosis. However, the relationship between AVS progression with cardiovascular (CV) risk has not been researched. This study investigates CV outcomes according to progression of AVS. Methods This study included 2,901 patients with AVS (irregular leaflet thickening and peak aortic jet velocity < 2 m/sec) who underwent serial echocardiograms at least 1 year apart during 2011–2020. The primary outcome was defined as CV death, myocardial infarction, stroke, or revascularization. Results During a median follow-up period of 3.9 years, 439 of 2,901 AVS patients (15.1%) progressed to mild or greater aortic stenosis. Patients with progression were older and more likely to have atrial fibrillation than those without. In a stepwise regression, age (odds ratio [OR] per 1-year increase, 1.04; 95% confidence interval [CI], 1.01– 1.07), peripheral artery disease (OR, 9.07; 95% CI, 3.12–26.4), and left ventricular mass index (OR per 1-g/m2 increase, 1.01; 95% CI, 1.00–1.02) were associated with AVS progression. Over a median of 6.3 years, the primary outcome occurred in 858 of 2,901 patients (29.6%). Patients with progression had higher frequency of CV death, myocardial infarction, stroke, or revascularization than those without progression (P < 0.0001). In Cox proportional hazards regression, AVS progression (hazard ratio, 1.33; 95% CI, 1.10–1.61) was a significant determinant of CV mortality. Conclusions The progression to aortic stenosis in AVS patients is an independent risk factor for CV mortality. These findings suggest that patients with AVS progression may benefit from stricter CV risk monitoring.
Abstract
Background Aortic valve sclerosis (AVS) shares risk factors with atherosclerosis. However, the relationship between AVS progression with cardiovascular (CV) risk has not been researched. This study investigates CV outcomes according to progression of AVS. Methods This study included 2,901 patients with AVS (irregular leaflet thickening and peak aortic jet velocity < 2 m/sec) who underwent serial echocardiograms at least 1 year apart during 2011–2020. The primary outcome was defined as CV death, myocardial infarction, stroke, or revascularization. Results During a median follow-up period of 3.9 years, 439 of 2,901 AVS patients (15.1%) progressed to mild or greater aortic stenosis. Patients with progression were older and more likely to have atrial fibrillation than those without. In a stepwise regression, age (odds ratio [OR] per 1-year increase, 1.04; 95% confidence interval [CI], 1.01– 1.07), peripheral artery disease (OR, 9.07; 95% CI, 3.12–26.4), and left ventricular mass index (OR per 1-g/m2 increase, 1.01; 95% CI, 1.00–1.02) were associated with AVS progression. Over a median of 6.3 years, the primary outcome occurred in 858 of 2,901 patients (29.6%). Patients with progression had higher frequency of CV death, myocardial infarction, stroke, or revascularization than those without progression (P < 0.0001). In Cox proportional hazards regression, AVS progression (hazard ratio, 1.33; 95% CI, 1.10–1.61) was a significant determinant of CV mortality. Conclusions The progression to aortic stenosis in AVS patients is an independent risk factor for CV mortality. These findings suggest that patients with AVS progression may benefit from stricter CV risk monitoring.
참고문헌 (26)
- Rajamannan NM, "Calcific aortic valve disease : not simply a degenerative process : a review and agenda for research from the National Heart and Lung and Blood Institute Aortic Stenosis Working Group. Executive summary : Calcific aortic valve disease-2011 update", Circulation, 124, pp.1783~1791 (2011)
- Coffey S, "The prevalence, incidence, progression, and risks of aortic valve sclerosis : a systematic review and meta-analysis", J Am Coll Cardiol, 63(25 Pt A), pp.2852~2861 (2014)
- Di Minno MN, "Cardiovascular morbidity and mortality in patients with aortic valve sclerosis : a systematic review and meta-analysis", Int J Cardiol, 260, pp.138~144 (2018)
- Gharacholou SM, "Aortic valve sclerosis and clinical outcomes : moving toward a definition", Am J Med, 124, pp.103~110 (2011)
- Stewart BF, "Clinical factors associated with calcific aortic valve disease : Cardiovascular Health Study", J Am Coll Cardiol, 29, pp.630~634 (1997)
- de AzevedoFilho AF, "Coronary artery disease in patients with aortic stenosis and transcatheter aortic valve implantation : implications for management", Eur Cardiol, 16, pp.e49~ (2021)
- Chandra HR, "Adverse outcome in aortic sclerosis is associated with coronary artery disease and inflammation", J Am Coll Cardiol, 43, pp.169~175 (2004)
- Otto CM, "Aortic stenosis : even mild disease is significant", Eur Heart J, 25, pp.185~187 (2004)
- Owens DS, "Aortic valve calcium independently predicts coronary and cardiovascular events in a primary prevention population", JACC Cardiovasc Imaging, 5, pp.619~625 (2012)
- Völzke H, "Heart valve sclerosis predicts all-cause and cardiovascular mortality", Atherosclerosis, 209, pp.606~610 (2010)
- Baumgartner H, "Recommendations on the echocardiographic assessment of aortic valve stenosis : a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography", Eur Heart J Cardiovasc Imaging, 18, pp.254~275 (2017)
- Messika-Zeitoun D, "Aortic valve calcification : determinants and progression in the population", Arterioscler Thromb Vasc Biol, 27, pp.642~648 (2007)
- Novaro GM, "Clinical factors, but not C-reactive protein, predict progression of calcific aortic-valve disease : the Cardiovascular Health Study", J Am Coll Cardiol, 50, pp.1992~1998 (2007)
- Otto CM, "Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly", N Engl J Med, 341, pp.142~147 (1999)
- Yan AT, "Association between cardiovascular risk factors and aortic stenosis : the CANHEART Aortic Stenosis Study", J Am Coll Cardiol, 69, pp.1523~1532 (2017)
- Owens DS, "Incidence and progression of aortic valve calcium in the Multi-ethnic Study of Atherosclerosis(MESA)", Am J Cardiol, 105, pp.701~708 (2010)
- Pradelli D, "Impact of aortic or mitral valve sclerosis and calcification on cardiovascular events and mortality : a meta-analysis", Int J Cardiol, 170, pp.e51~e55 (2013)
- Cosmi JE, "The risk of the development of aortic stenosis in patients with"benign"aortic valve thickening", Arch Intern Med, 162, pp.2345~2347 (2002)
- Otto CM, "Prospective study of asymptomatic valvular aortic stenosis : clinical, echocardiographic, and exercise predictors of outcome", Circulation, 95, pp.2262~2270 (1997)
- Rosenhek R, "Predictors of outcome in severe, asymptomatic aortic stenosis", N Engl J Med, 343, pp.611~617 (2000)
- Sverdlov AL, "Determinants of aortic sclerosis progression : implications regarding impairment of nitric oxide signalling and potential therapeutics", Eur Heart J, 33, pp.2419~2425 (2012)
- Di Minno MN, "Markers of subclinical atherosclerosis in patients with aortic valve sclerosis : a meta-analysis of literature studies", Int J Cardiol, 223, pp.364~370 (2016)
- Gaibazzi N, "Ultrasound carotid intima-media thickness, carotid plaque and cardiac calcium incrementally add to the Framingham Risk Score for the prediction of angiographic coronary artery disease : a multicenter prospective study", Int J Cardiol, 177, pp.708~710 (2014)
- Poggianti E, "Aortic valve sclerosis is associated with systemic endothelial dysfunction", J Am Coll Cardiol, 41, pp.136~141 (2003)
- Milin AC, "Insights into aortic sclerosis and its relationship with coronary artery disease", J Am Heart Assoc, 3, pp.e001111~ (2014)
- Prasad Y, "Aortic sclerosis : a marker of coronary atherosclerosis", Clin Cardiol, 27, pp.671~673 (2004)