Alterations in Cardiac Structure and Function Associated With Sub-Severe Aortic Stenosis Progression: The ARIC Study

BACKGROUND: American Heart Association and American College of Cardiology guidelines articulate 4 aortic stenosis (AS) stages to highlight its progressive nature, but limited data exist on cardiac alterations in sub-severe stages. METHODS: ARIC (Atherosclerosis Risk in Communities) study participants with protocol echocardiography at Visit 5 (V5; 2011–2013) and free of aortic valve (AV) replacement or cardiovascular disease were classified by ACC/AHA AS stages at V5 and Visit 7 (V7; 2018–2019). AS stage progression was defined as AV replacement or hospitalization, or a higher stage at V7. Associations of AS stage at V5 and AS stage progression from V5 to V7 with cardiac structure and function were assessed using multivariable linear regression. Associations of extra-AV cardiac abnormality categories with AS stage progression were assessed by multivariable logistic regression. RESULTS: Of 5206 V5 participants (age 75±5years, 40% men), AS stages A and B at V5 were associated with greater left ventricular wall thickness, mass, and filling pressure measures at both V5 and V7 compared with Stage 0. Among 1562 participants with assessable AS stage at V7, AS stage progression occurred in 370 and was associated with greater worsening of these measures (all P<0.02). The presence of both left ventricular and left atrial extra-AV abnormalities was associated with greater likelihood of AS stage progression (odds ratio 1.7 [95% CI, 1.2–2.6], P=0.009). CONCLUSIONS: Early AS stages are associated with greater left ventricular mass and diastolic dysfunction, and AS stage progression is associated with worsening of these measures. The presence of both left ventricular and left atrial extra-AV abnormalities is associated with a greater likelihood of early AS stage progression.