Aortic dP/dt as a new tool for prediction of aortic stenosis progression: a validation in a single-center cohort

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Abstract Introduction Aortic pressure increase per time unit (dP/dt) has been recently shown to predict the risk of progression of aortic stenosis (AS), with a proposed cut-off of 600 mmHg/s (Panel A). Whether it applies to other populations remains to be elucidated. Methods In this single-center retrospective study, we included patients with isolated moderate AS who had performed a complete transthoracic echocardiography (TTE) assessment in our center between 2014 and 2022. The primary endpoint was progression to severe AS, as documented by follow-up TTE. Uni- and multivariate analysis with Cox regression was used to assess the predictive value of dP/dt. Results A total of 103 patients were included, with a median age of 78 years (IQR 71 - 83), of which 58 (56%) were male. Median follow-up was 2.2 years (QR 1.1-3.7) and mean left ventricular ejection fraction (LVEF) was 54 ± 7%. We identified a total of 75 (73%) patients with a dP/dt ≥ 600mmHg/s; the mean value for dP/dt 737 ± 269 mmHg/s. Aortic dP/dt was independent of flow conditions, showing no correlation with stroke indexed volume (rho = 0.182; p = 0.08; r2 = 0.02) or LVEF (rho = 0.102; p = 0.31; r2 = 0.04). After adjustment for aortic maximum velocity (aHR 2.46 [1.08 - 5.5; p = 0.033]) and baseline creatinine (aHR 1.21 [1.06 - 1.37; p = 0.04]), dP/dt remained an independent predictor of progression to severe AS (aHR per 100 mmHg/s: 1.18 [1.03 - 1.34; p = 0.017]). The median time to AS progression was considerably shorter in patients with a dP/dt ≥ 600mmHg/s when compared with patients with a dP/dt < 600 mmHg/s (2.6 years [95%CI 2.0 – 3.3] vs. 5.3 years [95%CI 4.1-6.5]; Log-Rank p value < 0.001) (Panel B). The dP/dt cut-off of 600 mmHg/s had a sensitivity of 81% (95%CI: 69-90%), a specificity of 44% (95%CI: 30-60) a positive predictive value of 67% (95%CI 60-73%) and negative predictive value of 63% (95%IC: 48-75%). Conclusions Aortic dP/dt was validated in a single-center cohort of moderate aortic stenosis patients as an independent predictor of accelerated disease progression. This finding may help tailor individualized follow-up strategies.

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