Aortic valve stenosis (AS) is progressive disorder with variable rates of progression, but impact of baseline severity remained debated.

This systematic review and meta-analysis sought to assess whether baseline severity was predictive of AS progression rate.

We searched MEDLINE, Embase, and the Cochrane central Register of Controlled Trials from inception to July 1, 2020, for studies that prospectively evaluated either AS hemodynamic (mean pressure gradient, peak velocity/gradient, or valve area measured using transthoracic echocardiography) or anatomic (calcium score measured computed tomography) progression rate. We performed meta-analysis using a random effects model to determine the average rate of progression for each AS parameter and performed meta-regression to determine the association between baseline severity and rate of progression of AS.

Among 3899 studies screened, 24 (16 cohort studies, 8 randomized control trials, 6917 patients, 45% females) were included for the analysis. Pooled rate of progression for mean gradient was +4.2mmHg/year (95% CI: 2.7–5.6; 9 studies), peak gradient was +7.8mmHg/year (95% CI: 5.0–10.7; 7 studies), peak velocity was +0.20m/s/year (95% CI: 0.15–0.25; 11 studies), AV area was −0.08cm²/year (95% CI: 0.06–0.10; 11 studies), and AV calcium was +154 Agatston units (AU)/year (95% CI: 46–263; 6 studies). The baseline severity of AS was strongly associated with the rate of progression for mean gradient (P=0.005), peak velocity (P=0.004), and AV calcium (P<0.001) (Fig. 1a–c, respectively), but not with valve area (P=0.410).

AS progressed faster with increasing hemodynamic or anatomic severity. Our results suggest that medical therapy aiming at preventing AS progression might be of interest to treat the full spectrum of AS severity.