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Current Cardiology Reports Mar 2023This review summarizes the current management of patients with newly diagnosed aortic stenosis. (Review)
Review
PURPOSE OF REVIEW
This review summarizes the current management of patients with newly diagnosed aortic stenosis.
RECENT FINDINGS
Recent developments include detection of early myocardial dysfunction using serum B-type natriuretic peptide levels and global longitudinal strain, as well as ongoing trials of transcatheter aortic valve replacement in asymptomatic patients and patients with moderate aortic stenosis complicated by symptoms or left ventricular systolic dysfunction. Given the high mortality associated with severe symptomatic aortic stenosis, all symptomatic patients should be referred for aortic valve replacement. Asymptomatic patients with left ventricular systolic dysfunction, abnormal exercise stress test, high degree of stenosis, rapid disease progression, or elevated serum B-type natriuretic peptide level may also have an indication for valve replacement, based on established criteria. The progress in management of severe aortic stenosis has been in the direction of earlier detection and earlier valve replacement.
Topics: Humans; Natriuretic Peptide, Brain; Aortic Valve Stenosis; Aortic Valve; Ventricular Dysfunction, Left; Risk Assessment; Severity of Illness Index
PubMed: 36787025
DOI: 10.1007/s11886-022-01835-w -
Wiener Klinische Wochenschrift Dec 2020
Topics: Amyloidosis; Aortic Valve Stenosis; Humans
PubMed: 33306134
DOI: 10.1007/s00508-020-01787-7 -
Heart (British Cardiac Society) Jan 2023Mixed aortic stenosis (AS) and aortic regurgitation (AR) is the most frequent concomitant valve disease worldwide and represents a heterogeneous population ranging from... (Review)
Review
Mixed aortic stenosis (AS) and aortic regurgitation (AR) is the most frequent concomitant valve disease worldwide and represents a heterogeneous population ranging from mild AS with severe AR to mild AR with severe AS. About 6.8% of patients with at least moderate AS will also have moderate or greater AR, and 17.9% of patients with at least moderate AR will suffer from moderate or greater AS. Interest in mixed AS/AR has increased, with studies demonstrating that patients with moderate mixed AS/AR have similar outcomes to those with isolated severe AS. The diagnosis and quantification of mixed AS/AR severity are predominantly echocardiography-based, but the combined lesions lead to significant limitations in the assessment. Aortic valve peak velocity is the best parameter to evaluate the combined haemodynamic impact of both lesions, with a peak velocity greater than 4.0 m/s suggesting severe mixed AS/AR. Moreover, symptoms, increased left ventricular wall thickness and filling pressures, and abnormal left ventricular global longitudinal strain likely identify high-risk patients who may benefit from closer follow-up. Although guidelines recommend interventions based on the predominant lesion, some patients could potentially benefit from earlier intervention. Once a patient is deemed to require intervention, for patients receiving transcatheter valves, the presence of mixed AS/AR could confer benefit to those at high risk of paravalvular leak. Overall, the current approach of managing patients based on the dominant lesion might be too reductionist and a more holistic approach including biomarkers and multimodality imaging cardiac remodelling and inflammation data might be more appropriate.
Topics: Humans; Transcatheter Aortic Valve Replacement; Treatment Outcome; Aortic Valve Stenosis; Aortic Valve; Aortic Valve Insufficiency
PubMed: 35609962
DOI: 10.1136/heartjnl-2021-320501 -
JACC. Cardiovascular Imaging Jul 2021
Topics: Aortic Valve Disease; Aortic Valve Stenosis; Humans; Myocardium; Predictive Value of Tests
PubMed: 33865765
DOI: 10.1016/j.jcmg.2021.02.007 -
Heart (British Cardiac Society) May 2020
Topics: Aortic Valve; Aortic Valve Stenosis; Apolipoprotein C-III; Humans; Lipoprotein(a)
PubMed: 32086294
DOI: 10.1136/heartjnl-2019-316498 -
JACC. Cardiovascular Interventions Jun 2021
Topics: Aortic Valve Stenosis; Heart Valve Prosthesis; Humans; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 34112457
DOI: 10.1016/j.jcin.2021.03.063 -
Catheterization and Cardiovascular... Sep 2021
Topics: Aortic Valve Stenosis; Humans; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 34498391
DOI: 10.1002/ccd.29878 -
Progress in Cardiovascular Diseases 2020Bicuspid aortic valve (BAV) is the most common congenital cardiac abnormality in adults, and symptoms typically develops in adulthood. In the majority of cases, BAV... (Review)
Review
Bicuspid aortic valve (BAV) is the most common congenital cardiac abnormality in adults, and symptoms typically develops in adulthood. In the majority of cases, BAV disease progresses with age and surgical aortic valve replacement (AVR) is performed with excellent operative outcomes. Based on a series of randomized trials, transcatheter AVR (TAVR) has evolved from a novel technology to an established therapy for patients with symptomatic severe aortic stenosis (AS) regardless of risk profile. Despite exclusion of bicuspid anatomy from the randomized trials, an increasing number of patients with BAV-AS have been treated with TAVR. Recent observational studies showed the comparable outcomes of TAVR between bicuspid and tricuspid AS. However, worse outcomes in patients with unfavorable bicuspid anatomy such as calcified raphe plus excessive leaflet calcification have raised concerns for TAVR in younger and lower risk population. For the further expansion of TAVR toward BAV-AS population, we need randomized trials of TAVR in this population. Until then, previous registry data combined with computed tomographic-based anatomical assessment may guide the optimal therapy in patients with bicuspid anatomy.
Topics: Aortic Valve; Aortic Valve Stenosis; Bicuspid Aortic Valve Disease; Heart Valve Diseases; Humans; Transcatheter Aortic Valve Replacement
PubMed: 32592707
DOI: 10.1016/j.pcad.2020.06.007 -
Current Problems in Cardiology Dec 2021Rheumatic heart disease (RHD) mainly affects people in developing, low-income countries. However, due to globalization and migration, developed countries are now seeing... (Review)
Review
Rheumatic heart disease (RHD) mainly affects people in developing, low-income countries. However, due to globalization and migration, developed countries are now seeing more cases of RHD. In RHD patients who develop severe symptomatic aortic stenosis, surgical aortic valve replacement remains the treatment of choice. In the past decade, there has been an extension of transcatheter aortic valve replacement (TAVR) to intermediate-risk and lower-risk patients with aortic stenosis. This review suggests the possible utility of TAVR for the treatment of rheumatic aortic stenosis. Rheumatic aortic stenosis has been excluded from major TAVR studies due to the predominantly noncalcific pathology of the rheumatic aortic valve. However, there have been case reports and case series showing successful implantation of the valve even in patients with and without significant leaflet calcification. In this review article, we summarize the latest evidence of severe rheumatic aortic stenosis treated with TAVR and discuss the procedure's impact on patient care, safety, and efficacy.
Topics: Aortic Valve; Aortic Valve Stenosis; Calcinosis; Heart Valve Prosthesis Implantation; Humans; Risk Factors; Severity of Illness Index; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 33994024
DOI: 10.1016/j.cpcardiol.2021.100843 -
Internal Medicine (Tokyo, Japan) Sep 2023
Topics: Humans; Transcatheter Aortic Valve Replacement; Aortic Valve; Aortic Valve Stenosis
PubMed: 36725033
DOI: 10.2169/internalmedicine.1416-22