Aortic stenosis (AS) progression varies widely, making risk stratification and follow-up challenging in clinical practice. A retrospective cohort study published in Heart evaluated progression rates and factors associated with rapid hemodynamic worsening using real-world longitudinal data.

Adults aged ≥18 years were included if they had at least two transthoracic echocardiograms (TTEs) performed ≥180 days apart between 2011 and 2021. Rapid progression was defined as an annual increase in peak aortic jet velocity (Vmax) of ≥0.3 m/s/year. The analysis included 70,850 individuals contributing 111,189 TTE pairs.

Rapid progression rates differed by baseline severity. It occurred in 7.8% of individuals with aortic sclerosis, 16.4% with mild AS, and 29.8% with moderate AS. Across the cohort, mean Vmax increased by 0.1 m/s/year. Mean gradient increased by 1.6 mm Hg/year, and aortic valve area (AVA) declined by 0.1 cm²/year.

Among individuals with aortic sclerosis, rapid progression was associated with older age and comorbid conditions, including anemia, liver disease, renal failure, pulmonary disease, peripheral vascular disease, cancer, and obesity. In mild AS, anemia and obesity remained associated, while echocardiographic parameters such as higher gradient and smaller AVA showed stronger associations. In moderate AS, valve-related parameters were associated with progression, while clinical characteristics were not.

These findings show that AS progression varies by baseline severity and associated risk factors. Integration of clinical and echocardiographic variables may improve identification of individuals requiring closer surveillance.