Aortic sclerosis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]
Overview
Calcification of the aortic valve is common among the elderly population and shares epidemiologic and histopathologic similarities to atherosclerosis.[1] Progressive thickening and calcification of the aortic valve subsequently causes left ventricular stiffness resulting in left ventricular outflow tract obstruction, thereby leading to aortic stenosis.[2] Prognostically, it is known that aortic stenosis is clearly associated with adverse cardiovascular outcomes; however, it is unclear whether aortic sclerosis independently increases the risk of cardiovascular events or progression of aortic sclerosis to aortic stenosis increases the risk, including mortality.[2]
Natural History & Disease Progression
Progression to Aortic Stenosis
- The MESA study quantified aortic valve calcification by serial computed tomographic images from 5,880 participants aged 45 to 84 years. The incidence rate of aortic valve calcification was 1.7% per year and increased significantly with age.[1]
- Echocardiographic indicators of progression of aortic sclerosis to aortic stenosis include:
- Restricted leaflet mobility
- Increased echogenicity suggestive of increase leaflet calcification
- Increase in jet flow velocity across the valve
Prognosis
- Prognostically, it is known that aortic stenosis is clearly associated with adverse cardiovascular outcomes; however, it is unclear whether aortic sclerosis independently increases the risk of cardiovascular events or progression of aortic sclerosis to aortic stenosis increases the risk, including mortality.[2]
- Population-based prospective study, evaluated baseline echocardiograms obtained from 5621 men and women 65 years of age or older, off which 70% had normal aortic valve, 29% had aortic sclerosis without outflow obstruction and only 2% had aortic stenosis. During a mean 5-year follow-up, a stepwise significant increase in mortality was observed in patients with increasing aortic-valve abnormality. Thus, the study concluded an ~50% increase in the risk of death from cardiovascular causes and the risk of myocardial infarction in patients with aortic sclerosis, even in the absence of hemodynamically significant obstruction of left ventricular outflow.[2]
References
- ↑ 1.0 1.1 Owens DS, Katz R, Takasu J, Kronmal R, Budoff MJ, O'Brien KD (2010). "Incidence and progression of aortic valve calcium in the Multi-ethnic Study of Atherosclerosis (MESA)". The American Journal of Cardiology. 105 (5): 701–8. doi:10.1016/j.amjcard.2009.10.071. PMC 2829478. PMID 20185020. Retrieved 2012-04-11. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 2.2 2.3 Otto CM, Lind BK, Kitzman DW, Gersh BJ, Siscovick DS (1999). "Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly". The New England Journal of Medicine. 341 (3): 142–7. doi:10.1056/NEJM199907153410302. PMID 10403851. Retrieved 2012-04-11. Unknown parameter
|month=ignored (help)