Impact of aortic plaque on progression rate and prognosis of aortic stenosis

Abstract Backgrounds: Patients with aortic stenosis (AS) have a high prevalence of aortic plaque. However, no data exist regarding the clinical significance and prognostic value of aortic plaque in AS patients. This study examines the impact of aortic plaque on the rate of progression and clinical outcomes of AS. Methods: We retrospectively investigated 1812 transesophageal echocardiographic examinations between 2008 and 2015. We selected 100 consecutive patients (mean age; 75.1±7.4years) who showed maximal aortic jet velocity (AV-Vel) ≥2.0m/s by transthoracic echocardiography (TTE) and received follow-up TTE (mean follow-up duration 25±17months), and the mean progression rate of AV-Vel was calculated. Clinical and echocardiographic characteristics, including severity of aortic plaque, and cardiac events were examined. Results: At initial TTE, mean AV-Vel was 3.68±0.94m/s and mean aortic valve area 0.98±0.32cm 2 . Mean progression rate of AV-Vel was 0.41m/s/year in 38 patients with severe aortic plaque, and −0.03m/s/year in the remaining 62 patients without severe aortic plaque. Severe aortic plaque (odds ratio[ OR ], 8.32) and hemodialysis (OR, 6.03) were independent predictors of rapid progression. The event-free survival rate at 3years was significantly lower in patients with severe aortic plaque than in those without (52% vs 82%, p =0.002). Severe aortic plaque (hazard ratio[ HR ], 2.89) and AV-Vel at initial TTE (HR, 3.28) were identified as independent predictors of cardiac events. Conclusion: Severe aortic plaque was a predictor of rapid progression and poor prognosis in AS patients. Evaluation of aortic plaque provides additional information regarding surgical scheduling and follow-up.