Congenital valvular aortic stenosis in young adults: predictors for rate of progression of stenosis and aortic dilatation.

Autor: van der Linde D; Department of Cardiology, Thoraxcentre, Erasmus University Medical Centre, Rotterdam, The Netherlands., Andrinopoulou ER, Oechslin EN, Budts W, van Dijk AP, Pieper PG, Wajon EM, Post MC, Witsenburg M, Silversides CK, Oxenius A, Bogers AJ, Takkenberg JJ, Roos-Hesselink JW
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2013 Sep 30; Vol. 168 (2), pp. 863-70. Date of Electronic Publication: 2012 Nov 17.
DOI: 10.1016/j.ijcard.2012.10.027
Abstrakt: Background: Congenital aortic stenosis (AS) is the most common obstructive left-sided cardiac lesion in young adults, however little is known about the progression in adults. Therefore, we aimed to evaluate the progression rate of AS and aortic dilatation in a large multicenter retrospective cohort of asymptomatic young adults with congenital valvular AS.
Methods: Data were obtained from chart abstraction. Linear mixed-effects models were used to evaluate the progression of AS and aortic dilatation over time. A joint model combining longitudinal echocardiographic and survival data was used for survival analysis.
Results: A total of 414 patients (age 29 ± 10 years, 68% male) were included. Median follow-up duration was 4.1 (2.5-5.1) years (1587 patient-years). Peak aortic velocity was 3.4 ± 0.7 m/s at baseline and did not change over time in the total patient population (-0.01 ± 0.03 m/s/year). Increased left ventricular mass was significantly associated with faster AS progression (p<0.001). Aortic dilatation was present in 34% at baseline and 48% at follow-up (p<0.001). The aortic diameter linearly increased over time with a rate of 0.7 ± 0.2mm/year. Rate of aortic dissection was 0.06% per patient-year. Seventy patients required an aortic valve intervention (4.4% per patient-year), with AS progression rate as most powerful predictor (HR 5.11 (95% CI 3.47-7.53)).
Conclusions: In the majority of patients with mild-to-moderate congenital AS, AS severity does not progress over time. However patients with left ventricular hypertrophy are at risk for faster progression and should be monitored carefully. Although aortic dissections rarely occur, aortic dilatation is common and steadily progresses over time, warranting serial aortic imaging.
(Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)
Databáze: MEDLINE
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