Student intern Institut Universitaire de Cardiologie Et de Pneumologie de Québec Québec, Quebec, Canada
Background: Severe renal dysfunction is associated with faster progression of aortic stenosis (AS). However, the impact of earlier stages of renal impairment on AS progression has not been yet demonstrated. The present study thus aimed to examine the impact of non-severe renal impairment on the progression of AS and clinical outcomes in patients with AS.
METHODS AND RESULTS:
Methods: A total of two hundred and ninety-two patients with AS (mean age 71±12 years; 62% male) were included in this retrospective analysis. Clinical and imaging data, including Doppler echocardiography and multidetector computed tomography, were collected. Aortic valve area (AVA) and aortic valve calcification (AVC) were measured to assess the severity of AS and its progression. Annualized changes in AVA and AVC were calculated between baseline and the last follow-up.
Results: Over a mean follow-up of 5±2 years, patients with renal impairment had a faster progression of AVC compared to those with preserved renal function (144 [85–222] vs. 61 [3–153] AU/year, p=0.003). In multivariate analysis adjusted for age, sex, and AS severity at baseline, renal impairment remains independently associated with faster progression of AVC (p=0.009). Compared to men, lower estimated glomerular filtration rate (eGFR) in women was significantly associated with a faster decrease in AVA (r=0.35±0.00, p< 0.001). In multivariate analysis adjusted for age, hypertension, and AS severity at baseline, eGFR remains independently associated with a faster progression of AVA narrowing in women (p < 0.05). Thirty-eight patients (13%) died during follow-up. In multivariate Cox regression analysis, renal impairment was associated with increased risk of mortality (HR: 3.77, 95% CI [1.32–10.81], p=0.01). Aortic valve replacement (AVR) was performed in fifty-five patients (19%). There was no significant association between renal impairment and the incidence of AVR (HR: 1.23, 95% CI [0.71–2.14], p=0.47).
Conclusion: Non-severe renal dysfunction is associated with faster progression of AS, particularly in women, and with an increased risk of all-cause mortality. However, earlier AVR is not performed in patients with concomitant AS and non-severe renal impairment. These findings highlight the importance of early identification and targeted management of renal impairment in patients with AS to optimize outcomes and survival.
