Progression of aortic stenosis in adults: new insights provided by Doppler echocardiography.

Aortic stenosis is a progressive disease. The mechanisms and patterns of progression have been studied over the years using clinical assessment, cardiac catheterization, and more recently, Doppler echocardiography. Doppler is the ideal tool with which to study the progression of aortic stenosis since it provides accurate hemodynamic data non-invasively and, hence, can be repeated serially over long follow up periods. Recent Doppler echocardiographic studies have shown that the progression of aortic stenosis occurs with a wide range of individual variations, and that its rate and pattern cannot be predicted at the time of initial evaluation. However, it does follow a linear pattern, and individual trends can therefore be determined in a given patient. Symptoms lack specificity and, at a given point in time, do not predict progression. However, new and/or worsening symptoms are a mark of significant hemodynamic progression. The relationship between the cause of aortic stenosis and its progression remains imperfectly documented, and further longitudinal studies should focus on this question.