Initial changes in peak aortic jet velocity and mean gradient predict progression to severe aortic stenosis Arash Nayeri a,⇑ , Meng Xu b , Eric Farber-Eger b,c , Marcia Blair b,c , Inderpreet Saini a , Kamran Shamsa a , Gregg Fonarow a , Tamara Horwich a , Quinn S. Wells b,c a University of California, Los Angeles, CA, United States b Vanderbilt University Medical Center, Nashville, TN, United States c Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Nashville, TN, United States article info Article history: Received 28 May 2020 Received in revised form 24 June 2020 Accepted 13 July 2020 Keywords: Aortic stenosis Progression Echocardiography Peak aortic jet velocity (Vmax) Mean gradient (MG) abstract Background: There is significant interindividual variability in the rate of aortic stenosis (AS) progression that is not accounted for in the current surveillance algorithms. We sought to examine the association between changes in peak aortic jet velocity (Vmax) and mean gradient (MG) among patients with mild or moderate AS and risk of progression to severe disease. Methods: Adult subjects referred for echocardiography at a single academic referral center with a diag- nosis of mild or moderate AS and 2 additional surveillance echocardiograms were included in the study. Changes in Vmax and MG between the first two echocardiograms were indexed to time and tested for association with future progression to severe AS. Results: Among three hundred and sixty-four subjects, the median time between first and second echocardiograms was 1.3 years and initial changes in Vmax and MG indexed to time were +0.16 m/s per year and +1.44 mmHg per year, respectively. Fifty-three (15%) and fifty-six (15%) subjects progressed to severe AS defined by Vmax and MG, respectively. In multivariable logistic regression, initial increase in Vmax (OR = 4.19, 95% CI 1.93–9.10, p < 0.001) and initial increase in MG (OR = 1.12, 95% CI 1.06–1.18, p < 0.001) were associated with progression to severe AS. Conclusions: Initial changes in Vmax and MG among patients with mild or moderate AS are strongly asso- ciated with risk of progression to severe AS and may help guide individualized surveillance strategies. Ó 2020 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). 1. Introduction Aortic stenosis (AS) is the most common valvular heart disease in the developed world, affecting up to 10% of elderly patients [1,2]. Clinically, AS is classified as mild, moderate, or severe based on degree of hemodynamic obstruction, with severe AS further char- acterized as asymptomatic or symptomatic [3,4]. AS is generally regarded as a progressive condition and severe AS (particularly when symptomatic) has a dire prognosis without valvular inter- vention [5,6]. Current guidelines recommend routine monitoring of asymp- tomatic AS with echocardiography, where the frequency of surveil- lance is determined by disease severity [4]. These recommendations are based on average rates of change in the echocardiographic parameters that define severity of AS, even though the tempo of progression varies widely [3,7]. There is sig- nificant interindividual variability in the rate of AS progression that is not accounted for in the current surveillance algorithms based on average changes in echocardiographic parameters. Identifying predictors of disease progression could help estimate individual- ized risk and inform optimal surveillance strategies. We sought to examine the association of initial changes in echocardiographic measures of hemodynamic obstruction, namely peak aortic jet velocity (Vmax) and mean gradient (MG), in patients with mild or moderate AS with risk of disease progression to severe stage. We hypothesized that initial changes in these https://doi.org/10.1016/j.ijcha.2020.100592 2352-9067/Ó 2020 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). ⇑ Corresponding author at: University of California, Los Angeles, Department of Cardiovascular Medicine, 757 Westwood Plaza, St. 7501, Los Angeles, CA 90095-7417, United States. E-mail address: Anayeri@mednet.ucla.edu (A. Nayeri). IJC Heart & Vasculature 30 (2020) 100592 Contents lists available at ScienceDirect IJC Heart & Vasculature journal homepage: www.journals.elsevier.com/ijc-heart-and-vasculature