AS Progression Rates — EECC MCQ

Correct answer: B — Average progression: peak velocity increases by ~0.1-0.3 m/s per year and mean gradient by ~3-7 mmHg per year; faster progression occurs with bicuspid valves, heavy calcification, renal failure, and lipid disorders — there is significant individual variability

Calcific AS progression rates per the 2025 ESC VHD Guidelines: average increases of ~0.1-0.3 m/s/year in peak velocity and ~3-7 mmHg/year in mean gradient (AVA decreases by ~0.1 cm²/year). However, individual variability is significant. Factors accelerating progression: (1) BAV (earlier onset and potentially faster progression due to abnormal haemodynamic stress on the raphe); (2) heavy valve calcification (the major driver of progression); (3) CKD (accelerated vascular/valvular calcification); (4) elevated Lp(a) and LDL-C (the Mendelian randomisation evidence linking Lp(a) to AS); (5) diabetes; (6) older age. No pharmacological therapy has been proven to slow AS progression (statins — SEAS, SALTIRE, ASTRONOMER trials were negative). This information guides surveillance frequency: mild AS every 2-3 years, moderate AS annually, severe AS every 6-12 months.

Reference: ESC/EACTS (2025): VHD Guidelines