CONGRESS ABSTRACT

We investigated predictors of aortic stenosis (AS) progression in 20 consecutive patients (pts) every 6 months for 24 months with clinical controls, echocardiograms and biochemical variables. The changes evuated were: every 6 months clinical status and mean gradient [MG], peak velocity [PV], peak gradient [PG], or aortic valve area [AVA]) ; at baseline and after 24 months : calcium score [AVC] at computed tomography . Pts with obesity (BMI ≥30.0 kg/m²) and/or hip circumference /height ratio >0.5 were treated with Glucagon-Like Peptide-1 Receptor Agonist semaglutide (GLP1-RA) subcutaneously once weekly . During the first 16 weeks, the dose of semaglutide was gradually escalated from 0.25 mg once weekly until the target dose. Pts with diabetes mellitus were excluded from the study. Pts with LDL levels > 110 mg were treated with rosuvastatin 20 mg + ezetimibe 10 mg . Resuts:The pooled annualized progression of MG was +4.80 mm Hg (95% CI: 2.80-5.41 mm Hg), AVA −0.10 cm2 (95% CI: 0.06-0.12 cm2), PV +0.20 m/s (95% CI: 0.13-0.24 m/s), PG +8.8 mm Hg (95% CI: 5 -10.75 mm Hg), and AVC +160 AU (95% CI: 50-265 AU).The reduction in AVA per year was significantly related to initial AVA (r=0.42, P<0.0001), mean aortic valve gradient (r=0.28, P=0.04), left ventricular (LV) outflow tract velocity (r=0.28, P=0.001), LV end-diastolic diameter (r=0.24, P=0.04) and to serum creatinine level (r=0.15, P=0.08).Pts with a faster rate of reduction in AVA had higher serum creatinine (P=0.04) and calcium (P=0.08) levels.Those with a serum LDL >110 mg/dL had a rate of AVA reduction twice that of those with a lower cholesterol level (P=0.04). Initial AVA, current smoking, and serum calcium level were independent predictors of amount of AVA reduction per year. During a mean follow-up of 24 months , the changes in body weight, BMI, waist-to-hip ratio, and NYHA functional class correlated well with a slowing of the stenotic AVA progression in treated pts with semaglutide + rosuvastatin and ezetimibe (-0.10 ± 0.09 cm² /year). Conclusion:Absolute and percentage AVA progression per year is greater in those with milder degrees of stenosis, higher body mass index, hip circumference / height ratio>0.5. Aortic stenosis progression is accelerated in the presence of smoking, hypercholesterolemia, lower BMI, and elevated serum creatinine and calcium levels.The use of GLP1-RA semaglutide plus rosuvastatin and ezetimibe seems to be a possible strategy to retard this process.