Progression of aortic valve stenosis in adults: A systematic review

Background and aim of the study: Published reports on the progression of aortic valve stenosis (AS) over time are usually small, with widely varying AS progression rate estimates. Reliable estimates of AS progression are important for surveillance scheduling and optimal timing of surgical or interventional treatment. This systematic review presents an overview of published evidence on AS progression over time in adult patients with AS. Methods: A systematic review using PubMed and Embase was performed to assess AS progression over time in adult patients with AS measured by echocardiography. A total of 27 reports (15 prospective, 12 retrospective, total 4,921 patients, pooled age 69 years) was included in which the baseline and progression rates of the hemodynamic variables were pooled. Subgroup analyses were performed to investigate factors associated with AS progression and sources of heterogeneity. Results: Pooled annual AS progression was 3.70 mmHg per year (SE = 0.10) for randomized controlled trials, and 6.03 mmHg per year (SE = 0.10) for observational studies. A large variability in observed AS progression was found between studies, as well as a wide variety of methods employed to measure AS. Conclusion: The observed large individual variability in measuring AS progression among the selected studies calls for the implementation of a universal method of AS assessment. This will facilitate an insight into the determinants of AS progression and allow for an evidence-based tailoring of treatment.

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