Moderate Aortic Stenosis: Should You Wait Until It Becomes Severe?
Aortic stenosis—narrowing of the heart’s aortic valve that reduces blood flow from the heart to the body—affects more than 3% of adults aged 65 and older. Current guidelines generally recommend an echocardiogram every one to two years for patients with moderate disease, with valve replacement reserved for when stenosis becomes severe or another indication for surgery develops.
But an international clinical trial called PROGRESS suggests a different approach: for some patients with moderate aortic stenosis and “at-risk” features, earlier transcatheter aortic valve replacement (TAVR) may provide benefit.
How the Study Was Done
The PROGRESS trial enrolled 744 patients aged 65 or older at 74 centers in six countries. All had moderate aortic stenosis and at least one feature indicating increased risk, such as symptoms or abnormalities in heart structure or function. Participants were randomly assigned to:
- TAVR group: 373 patients who underwent earlier transcatheter aortic valve replacement;
- Clinical surveillance group: 371 patients managed with routine monitoring, with valve replacement available when indicated.
Key Finding: Heart-Failure Hospitalizations Halved
After two years:
- 23.9% of patients in the surveillance group experienced heart failure or died, compared with 16.7% in the TAVR group;
- Heart-failure hospitalization occurred in 7.4% of TAVR patients versus 14.9% of surveillance patients—about half the rate.
“Patients with moderate aortic stenosis can already have symptoms and signs that their heart is under strain,” said Raj Makkar, MD, vice president of Cardiovascular Innovation and Intervention in the Smidt Heart Institute at Cedars-Sinai and national principal investigator for the trial. “These results show that for selected patients with at-risk features, treating the valve earlier can reduce the risk of heart-failure events before the narrowing becomes severe.”
Co-author Aakriti Gupta, MD, added: “More than half of the patients initially assigned to surveillance underwent valve replacement within two years, suggesting that the disease can progress quickly from moderate to severe in some patients.”
This Does Not Mean Everyone Should Have Early TAVR
The researchers emphasize that the findings do not mean every patient with moderate aortic stenosis should undergo TAVR. The team plans to follow participants for 10 years to determine whether the early reduction in heart-failure events translates into longer survival. They will also assess valve durability, the potential need for future procedures, and which patients are most likely to benefit.
Because participants were an average of 78 years old, researchers will also examine whether the findings apply to younger patients or those without the at-risk features studied in PROGRESS.
Practical Takeaways for Patients
- If you have moderate aortic stenosis, keep up with scheduled echocardiograms—do not stop follow-up on your own;
- Tell your doctor promptly if you develop shortness of breath with activity, fatigue, chest tightness, or leg swelling;
- Whether to proceed with earlier valve replacement should be individualized by a heart team, considering symptoms, heart structure and function, and procedural risk;
- Treatment decisions should be based on shared decision-making—not a one-size-fits-all rule.
Tracking symptom changes, weight, blood pressure, and heart rate can help clinicians assess your condition over time. The Xiaoshu Health App can sync with Apple Health to track relevant metrics, helping you organize health data for more informed conversations at follow-up visits.