Why is aortic sclerosis associated with adverse clinical outcomes?

Calcific aortic valve disease encompasses a range of disease severity from mild leaflet thickening without valve obstruction, called “aortic sclerosis,” to severe aortic stenosis. It is intuitive that severe obstruction in blood flow at the valve level results in poor clinical outcomes and that relief from the obstruction by valve replacement corrects the problem. However, we now recognize that milder degrees of calcific valve disease are also associated with adverse clinical outcomes. In the absence of altered valve hemodynamics, the mechanism of this association is not obvious.