Details

Autor(en) / Beteiligte

• Lindman, Brian R.
• Dweck, Marc R.
• Lancellotti, Patrizio
• Généreux, Philippe
• Piérard, Luc A.
• O’Gara, Patrick T.
• Bonow, Robert O.

Titel

Management of Asymptomatic Severe Aortic Stenosis

Ist Teil von

• JACC. Cardiovascular imaging, 2020-02, Vol.13 (2), p.481-493

Ort / Verlag

Elsevier Inc

Erscheinungsjahr

2020

Link zum Volltext

Quelle

Elsevier ScienceDirect Journals Complete

Beschreibungen/Notizen

• New insights into the pathophysiology and natural history of patients with aortic stenosis, coupled with advances in diagnostic imaging and the dramatic evolution of transcatheter aortic valve replacement, are fueling intense interest in the management of asymptomatic patients with severe aortic stenosis. An intervention that is less invasive than surgery could conceivably justify pre-emptive transcatheter aortic valve replacement in subsets of patients, rather than waiting for the emergence of early symptoms to trigger valve intervention. Clinical experience has shown that symptoms can be challenging to ascertain in many sedentary, deconditioned, and/or elderly patients. Evolving data based on imaging and biomarker evidence of adverse ventricular remodeling, hypertrophy, inflammation, or fibrosis may radically transform existing clinical decision paradigms. Clinical trials currently enrolling asymptomatic patients have the potential to change practice patterns and lower the threshold for intervention. [Display omitted] •Although AS is the most common heart valve lesion encountered in clinical practice, affecting 2% to 5% of older adults, determining its severity in asymptomatic patients remains problematic.•New methods of risk stratification for asymptomatic patients with AS are emerging, including circulating biomarkers, Doppler-derived global longitudinal strain, and magnetic resonance assessment of left ventricular myocardial fibrosis.•Prospective randomized trials are underway for asymptomatic patients with AS to assess timing of aortic valve replacement and determinants of clinical outcomes.