AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Population-Level Outcomes Across the Aortic Valve Disease Continuum: A Large Language Model-Enabled Retrospective Cohort Study
By Navindi D, Chen W, Zhou M et al.
Background: Aortic valve disease spans a continuum from sclerosis to severe aortic stenosis. Prior studies show stepwise increases in mortality, but population-level data remain limited. Transthoracic echocardiography (TTE) reports contain rich clinical detail but exist as unstructured text; large language models (LLM) now enable population-scale extraction and classification of disease severity. Understanding outcome gaps across this spectrum is critical to improving risk stratification and reducing disparities. Research Question: How do cardiovascular hospitalization and mortality vary across the aortic valve disease continuum, and which clinical and TTE factors independently predict events within each severity? Methods: We conducted a retrospective cohort study of adults who underwent TTE at a large integrated healthcare system in Southern California (2011–2021). Aortic valve disease was classified into sclerosis, mild, moderate, and severe aortic stenosis (AS) using a validated LLM applied to TTE reports; prior aortic valve replacement was excluded. Outcomes were identified using ICD-9/ICD-10 and procedural codes, with follow-up through December 2024. Hospitalization and valve replacement rates were calculated per 1,000 person-years; multivariable Cox proportional hazards models estimated adjusted associations with 99% confidence intervals. Results: Among 243,928 patients (sclerosis N=180,734; mild AS N=35,896; moderate AS N=16,616; severe AS N=10,682), mean age increased with disease severity, and 65% were ≥70 years. Rates of acute major CV hospitalization rose from 43.7 per 1,000 person-years in sclerosis to 205.2 in severe AS, while hospitalization for any CV disease increased from 57.8 to 568.8 per 1,000 person-years. Heart failure-specific events demonstrated similar gradients, increasing from 14.9 to 71.1 per 1,000 person-years. After multivariable adjustment, older age, heart failure, renal failure, and atrial fibrillation were strongly associated with increased risk of acute CV hospitalization or death across all severity strata. Heart failure conferred consistent risk (HR 1.54–1.86 across classes), while reduced LVEF was also independently associated with adverse outcomes. Male sex was associated with modestly higher CV risk (HR approximately 1.11–1.18 across severity strata). Hispanic and Asian patients had lower adjusted risks of CV events compared with non-Hispanic White patients, whereas Black patients had similar risk profiles. Conclusions: Cardiovascular morbidity increases markedly across the aortic valve disease continuum, with gradients beginning at early disease stages. Traditional clinical risk factors and echocardiographic parameters independently stratify risk across all severity classes. These findings support earlier risk identification and targeted strategies across the disease spectrum.