Clinical approach to patients with aortic stenosis

Czech version

Authors: K. Linhartová
Authors‘ workplace: Kardiochirurgické oddělení, FN Plzeň Kardiologie v sadech, s. r. o., Plzeň
Published in: Kardiol Rev Int Med 2015, 17(4): 322-324
Category: Cardiology Review

Overview

Aortic stenosis is the most frequently corrected valve disease affecting 2.5% of persons over 65 years. Aortic stenosis is always progressive, while the rate of progression varies. Aortic valve replacement is indicated in patients with severe symptomatic aortic stenosis or ejection fraction (< 50%). Patients with asymptomatic aortic stenosis who can profit from early surgery are selected by risk stratification. Surgical aortic valve replacement is standard in patients with low and medium risk. TAVI 5-year results are similar to surgery in high risk patients and better than conservative treatment in inoperable patients. The choice of TAVI vs. surgery is a team decision based on the overall risk and anatomical factors of aortic stenosis.

Keywords:
aortic stenosis – calcification – aortic valve replacement – TAVI – exercise test

Sources

1. Stewart BF, Siscovick D, Lind BK et al. Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol 1997; 29: 630–634.

2. Linhartová K. Diagnostika aortální stenózy. Kardiol Rev Int Med 2013; 15: 141–143.

3. Lee SP, Lee W, Lee JM et al. Assessment of diffuse myocardial fibrosis by using MR imaging in asymptomatic patients with aortic stenosis. Radiology 2015; 274: 359–369. doi: 10.1148/ radiol.14141120.

4. Vahanian A, Alfieri O, Andreotti F et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012; 33: 2451–2496. doi: 10.1093/ eurheartj/ ehs109.

5. Nishimura RA, Otto CM, Bonow RO et al. 2014 AHA/ ACC Guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129: 2440–2492. doi: 10.1161/ CIR.0000000000000029.

6. Michelena HI, Desjardins VA, Avierinos JF et al. Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community. Circulation 2008; 117: 2776–2784. doi: 10.1161/ CIRCULATIONAHA.107.740878.

7. Rashedi N, Otto CM. Aortic stenosis: Changing disease concepts. J Cardiovasc Ultrasound 2015; 23: 59–69. doi: 10.4250/ jcu.2015.23.2.59.

8. Linhartová K, Filipovský J, Cerbák R et al. Severe aortic stenosis and its association with hypertension: analysis of clinical and echocardiographic parameters. Blood Press 2007; 16: 122–128.

9. Rossebø AB, Pedersen TR, Boman K. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med 2008; 359: 1343–1356. doi: 10.1056/ NEJMoa0804602.

10. Kang DH, Park SJ, Rim JH. Early surgery versus conventional treatment in asymptomatic very severe aortic stenosis. Circulation 2010; 121: 1502–1509. doi: 10.1161/ CIRCULATIONAHA.109.909903.

11. Rosenhek R, Zilberszac R, Schemper M. Natural history of very severe aortic stenosis. Circulation 2010; 121: 151–156. doi: 10.1161/ CIRCULATIONAHA.109.894170.

12. Clavel MA, Malouf J, Michelena HI et al. B-type natriuretic peptide clinical activation in aortic stenosis: impact on long-term survival. J Am Coll Cardiol 2014; 63: 2016–2025. doi: 10.1016/ j.jacc.2014.02.581.

13. Mack MJ, Leon MB, Smith CR et al. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet 2015; 385: 2477–2484. doi: 10.1016/ S0140-6736(15)60308-7.

14. Kapadia SR, Leon MB, Makkar Rr et al. 5-year outcomes of transcatheter aortic valve replacement compared with standard treatment for patients with inoperable aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet 2015; 385: 2485–2491. doi: 10.1016/ S0140-6736(15)60290-2.

15. Pawade TA, Newby D, Dweck M. Study investigating the effect of drugs used to treat osteoporosis on the progression of calcific aortic stenosis. (SALTIRE II). NCT02132026. Available from: https:/ / clinicaltrials.gov/ ct2/ show/ NCT02132026.