Abstract
Background: Aortic sclerosis (ASc) has been associated with higher rates of myocardial infarction and stroke. However, whether ASc progresses to clinically significant valve disease is unclear, with a relatively low rate of progression to AS in cohort studies. We examined the long-term outcomes of patients with ASc and mild aortic stenosis (AS) on clinically indicated echocardiography.
Method: First echocardiography reports in patients aged >18 years in one district health board from 2010 to 2018 were extracted, and linked to the National Minimum Dataset and Mortality Collection. Those with significantly impaired function or other significant valve disease were excluded. A time to first event analysis was performed, with the primary outcome a composite of cardiovascular death and aortic valve replacement.
Results: Of the 13,313 patients, 8,973 had no calcific aortic valve disease (CAVD), 3,436 had ASc, and 455 had mild AS. The remainder had moderate or worse stenosis. Patients were followed up for a median of 4.2 years (interquartile range [IQR], 1.8 – 6.7 years). Compared to those with no disease, those with sclerosis were at greater risk of the primary outcome (HR 2.86, 95% CI 2.05-3.99) and aortic valve replacement (AVR) (HR 26.81, 95% CI 9.09-79.10) after adjustment for age and sex. The event rate in those with mild AS begins to accelerate after approximately five years.
Conclusion: Patients with aortic sclerosis are over 25 times more likely to require AVR than those with no CAVD. Patients with mild AS should be considered for repeat imaging after approximately 3-4 years.