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
- 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
- Based on a database study from 1987 to 1993, that evaluated 2131 cases of aortic valve thickening with minimum 1-year echocardiographic follow-up, reported the development of aortic stenosis in 15.9% cases, of which 10.5% developed mild AS, 2.9% had moderate AS and 2.5% had severe AS. Thus, this study demonstrated the prevalence of benign aortic valve thickening with the progression to significant aortic stenosis.[3][4]
- Another large population-based cohort reported an ~9% of subjects with aortic sclerosis progressed to aortic stenosis over a 5-year echocardiographic follow-up. Additionally, no association was observed between C-reactive protein levels and the presence of calcific aortic-valve disease or incidental aortic stenosis. However, if C-reactive protein was present it was a poor predictor of subclinical calcific aortic-valve disease.[5]
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]
- Similar association between aortic sclerosis and the incidence of new coronary events were reported in multiple prospective studies[6][7] and was independent of co-existing cardiovascular disease or traditional cardiovascular risk factors.[8]
References
- ↑ 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) - ↑ Cosmi JE, Kort S, Tunick PA, Rosenzweig BP, Freedberg RS, Katz ES, Applebaum RM, Kronzon I (2002). "The risk of the development of aortic stenosis in patients with "benign" aortic valve thickening". Archives of Internal Medicine. 162 (20): 2345–7. PMID 12418948. Retrieved 2012-04-11. Unknown parameter
|month=ignored (help) - ↑ Faggiano P, Antonini-Canterin F, Erlicher A, Romeo C, Cervesato E, Pavan D, Piazza R, Huang G, Nicolosi GL (2003). "Progression of aortic valve sclerosis to aortic stenosis". The American Journal of Cardiology. 91 (1): 99–101. PMID 12505585. Retrieved 2012-04-11. Unknown parameter
|month=ignored (help) - ↑ Novaro GM, Katz R, Aviles RJ, Gottdiener JS, Cushman M, Psaty BM, Otto CM, Griffin BP (2007). "Clinical factors, but not C-reactive protein, predict progression of calcific aortic-valve disease: the Cardiovascular Health Study". Journal of the American College of Cardiology. 50 (20): 1992–8. doi:10.1016/j.jacc.2007.07.064. PMID 17996566. Retrieved 2012-04-11. Unknown parameter
|month=ignored (help) - ↑ Aronow WS, Ahn C, Shirani J, Kronzon I (1999). "Comparison of frequency of new coronary events in older subjects with and without valvular aortic sclerosis". The American Journal of Cardiology. 83 (4): 599–600, A8. PMID 10073870. Retrieved 2012-04-11. Unknown parameter
|month=ignored (help) - ↑ Taylor HA, Clark BL, Garrison RJ, Andrew ME, Han H, Fox ER, Arnett DK, Samdarshi T, Jones DW (2005). "Relation of aortic valve sclerosis to risk of coronary heart disease in African-Americans". The American Journal of Cardiology. 95 (3): 401–4. doi:10.1016/j.amjcard.2004.09.043. PMID 15670554. Retrieved 2012-04-11. Unknown parameter
|month=ignored (help) - ↑ Olsen MH, Wachtell K, Bella JN, Gerdts E, Palmieri V, Nieminen MS, Smith G, Ibsen H, Devereux RB (2005). "Aortic valve sclerosis relates to cardiovascular events in patients with hypertension (a LIFE substudy)". The American Journal of Cardiology. 95 (1): 132–6. doi:10.1016/j.amjcard.2004.08.080. PMID 15619412. Retrieved 2012-04-11. Unknown parameter
|month=ignored (help)