How can progression be predicted in patients with mild to moderate aortic valve stenosis?

Abstract

Aims The pressure increase per time unit (dP/dt) in aortic stenosis (AS) jet velocity is assumed to have inter-individual variability in the progressive AS stage. We sought to examine the association of aortic valve (AoV) Doppler-derived dP/dt in patients with mild to moderate AS with risk of progression to severe disease. Methods and results A total of 481 patients diagnosed with mild or moderate AS [peak aortic jet velocity (Vmax) between 2 and 4 m/s] according to echocardiographic criteria were included. AoV Doppler-derived dP/dt was determined by measuring the time needed for the pressure to increase at a velocity of the AoV jet from 1 m/s to 2 m/s. During a median follow-up period of 2.7 years, 12 of 404 (3%) patients progressed from mild to severe AS and 31 of 77 (40%) patients progressed from moderate to severe AS. AoV Doppler-derived dP/dt had a good ability to predict risk of progression to severe AS (area under the curve = 0.868) and the cut-off value was 600 mmHg/s. In multivariable logistic regression, initial AoV calcium score (adjusted odds ratio [aOR], 1.79; 95% confidence interval [CI], 1.18–2.73; P = 0.006) and AoV Doppler-derived dP/dt (aOR, 1.52/100 mmHg/s higher dP/dt; 95% CI, 1.10–2.05; P = 0.012) were associated with progression to severe AS. Conclusion AoV Doppler-derived dP/dt above 600 mmHg/s was associated with risk of AS progression to the severe stage in patients with mild to moderate AS. This may be useful in individualized surveillance strategies for AS progression.

A Multimodality Video-Based AI Biomarker For Aortic Stenosis Development And Progression

“…Prior efforts in this space have focused on identifying a broader range risk factors that are independently associated with AS progression, including traditional risk factors such as hypercholesterolemia, smoking, renal dysfunction, and elevated natriuretic peptide levels, which lack specificity for AS (10,27). Alternative Doppler-derived indices require skilled acquisition and modifications to the scanning and reporting protocols (27,28), whereas multi-modal imaging solutions such as with targeted positron-emission tomography radiotracers to detect active microcalcification (29) can be costly and is not readily available.…”

“…Critically, DASSi has several features that make it generalizable and scalable. Unlike prior methods that have utilized structured echo reports and measurements (28,(30)(31)(32), Doppler images (33) or still images of the aortic valve (34), DASSi can be directly applied to unprocessed, standard PLAX videos, without the need for any Doppler or two-dimensional measurements. This minimizes potential information loss and provides a quality-controlled, reader-independent metric to supplement a trained echocardiographer's impression.…”

A Multimodal Video-Based AI Biomarker for Aortic Stenosis Development and Progression

“…[32][33][34][35] Traditional risk factors, such as hypercholesterolemia, smoking, kidney dysfunction, and elevated natriuretic peptide levels, lack specificity for AS, 15,36 while alternative Doppler-derived indices require skilled acquisition and modifications to the scanning protocols. 36,37 Deep learning-enhanced, 2-dimensional echocardiography with DASSi aims to bridge this gap by providing a Dopplerindependent AS severity metric that can be computed from any portable or standard echocardiogram. Trained to detect generalizable features associated with the severe AS phenotype, 16 DASSi maintains its prognostic value across the spectrum of AS stages, identifying individuals who do not meet traditional criteria for severe AS, yet exhibit fast rates of progression.…”

“…However, a challenge in personalizing patient follow-up is the marked variability in the progression rates of patients within similar Doppler-adjudicated severity stages . Traditional risk factors, such as hypercholesterolemia, smoking, kidney dysfunction, and elevated natriuretic peptide levels, lack specificity for AS, while alternative Doppler-derived indices require skilled acquisition and modifications to the scanning protocols …”

“…Critically, DASSi has several features that make it generalizable and scalable. Unlike prior methods that have used structured echocardiographic reports and measurements, Doppler images, or still images of the aortic valve, DASSi can be directly applied to unprocessed, standard PLAX videos without the need for any Doppler or 2-dimensional measurements. It provides a reader-independent metric to supplement an echocardiographer’s impression, assisting in standardized severity classification .…”