CLINICAL PREDICTORS OF AORTIC STENOSIS PROGRESSION

Abstract

Objective. The aim is to identify clinical predictors associated with high-gradient aortic stenosis (AS). Materials and Methods. A comparative cross-sectional study was carried out involving patients diagnosed with moderate and severe AS. For the purpose of analysis, patients were categorized based on their mean transaortic gradient: Group 1 (low-gradient AS) comprised individuals with a mean gradient of less than 40 mmHg, while Group 2 (high-gradient AS) consisted of those with a mean gradient of 40 mmHg or greater. The study employed various methods, including evaluations of general clinical parameters, laboratory tests, and instrumental examinations. Transthoracic echocardiography was conducted using an EnVisor C ultrasound system (Philips, the Netherlands) equipped with a 3.5 MHz sector transducer, following standard M- and B-mode techniques. Statistical analysis was executed using RStudio (version X.X.X, R language). Results. All patients included in the study presented with comorbidities; however, no significant differences in the prevalence of cardiovascular and concomitant diseases were observed between the groups. Group 2 exhibited statistically significant elevations in potassium levels (p = 0.008), while triglyceride levels were found to be 19.4% lower in this group (p = 0.010). In terms of structural and functional parameters, patients in group 2 demonstrated a higher mean and maximum aortic pressure gradient, with increases of 1.8 (p < 0.001) and 1.7 (p<0.001) times, respectively, alongside a greater degree of aortic calcification (p=0.001). It is important to note that 14% of patients in group 1 showed no evidence of left ventricular hypertrophy (LVH), whereas all patients in group 2 were characterized by the presence of LVH. The logistic regression analysis identified the following predictors of high-gradient aortic stenosis (AS): the presence of peripheral artery stenosis (OR = 2.6 [CI 0.97929893-8.525276], p-value 0.0735) and triglyceride levels (OR = 0.27 [CI 0.02118769-1.460478], p-value 0.2027). Conclusion. Patients diagnosed with aortic stenosis (AS) exhibit comorbid conditions; however, no significant variations in the occurrence of cardiovascular and associated diseases were observed based on the severity of AS. Factors predictive of advanced AS included the existence of peripheral arterial stenosis and levels of triglycerides. A broader investigation into markers indicative of the progression of aortic valve calcification could assist healthcare providers in establishing the most effective follow-up schedule for AS patients and in recognizing potential preventive strategies.