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American Family Physician Mar 2016Aortic stenosis affects 3% of persons older than 65 years. Although survival in asymptomatic patients is comparable to that in age- and sex-matched control patients, it... (Review)
Review
Aortic stenosis affects 3% of persons older than 65 years. Although survival in asymptomatic patients is comparable to that in age- and sex-matched control patients, it decreases rapidly after symptoms appear. During the asymptomatic latent period, left ventricular hypertrophy and atrial augmentation of preload compensate for the increase in afterload caused by aortic stenosis. As the disease worsens, these compensatory mechanisms become inadequate, leading to symptoms of heart failure, angina, or syncope. Aortic valve replacement is recommended for most symptomatic patients with evidence of significant aortic stenosis on echocardiography. Watchful waiting is recommended for most asymptomatic patients. However, select patients may also benefit from aortic valve replacement before the onset of symptoms. Surgical valve replacement is the standard of care for patients at low to moderate surgical risk. Transcatheter aortic valve replacement may be considered in patients at high or prohibitive surgical risk. Patients should be educated about the importance of promptly reporting symptoms to their physicians. In asymptomatic patients, serial Doppler echocardiography is recommended every six to 12 months for severe aortic stenosis, every one to two years for moderate disease, and every three to five years for mild disease. Cardiology referral is recommended for all patients with symptomatic moderate and severe aortic stenosis, those with severe aortic stenosis without apparent symptoms, and those with left ventricular systolic dysfunction. Medical management of concurrent hypertension, atrial fibrillation, and coronary artery disease will lead to optimal outcomes.
Topics: Aortic Valve Stenosis; Echocardiography; Heart Valve Prosthesis; Humans; Severity of Illness Index
PubMed: 26926974
DOI: No ID Found -
Hellenic Journal of Cardiology : HJC =... 2017Arterial hypertension and aortic valve stenosis are common disorders and frequently present as concomitant diseases, especially in elderly patients. The impact of... (Review)
Review
Arterial hypertension and aortic valve stenosis are common disorders and frequently present as concomitant diseases, especially in elderly patients. The impact of hypertension on heart haemodynamics is substantial, thus affecting the clinical presentation of any coexisting valvulopathy, especially of aortic stenosis. However, the interaction between these 2 entities is not thoroughly discussed in the European or/and American guidelines on the management of hypertension or/and valvular heart disease. The present review summarizes all available evidence on the potential interplay between hypertension and aortic valve stenosis, aiming to help physicians understand the pathophysiology and select the best diagnostic and therapeutic strategies (medical or/and interventional) for better management of these high-risk patients, taking into account the impact on outcome as well as the risk-benefit-ratio.
Topics: Aged; Aged, 80 and over; Aortic Valve; Aortic Valve Stenosis; Female; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Hypertension; Male; Practice Guidelines as Topic; Prevalence; Prognosis; Risk Factors
PubMed: 28351655
DOI: 10.1016/j.hjc.2017.03.005 -
Physiology (Bethesda, Md.) May 2017Our understanding of the fundamental biology and identification of efficacious therapeutic targets in aortic valve stenosis has lagged far behind the fields of... (Review)
Review
Our understanding of the fundamental biology and identification of efficacious therapeutic targets in aortic valve stenosis has lagged far behind the fields of atherosclerosis and heart failure. In this review, we highlight the most clinically relevant problems facing men and women with fibrocalcific aortic valve stenosis, discuss the fundamental biology underlying valve calcification and fibrosis, and identify key molecular points of intersection with sex hormone signaling.
Topics: Aortic Valve Stenosis; Female; Fibrosis; Gonadal Steroid Hormones; Humans; Male; Models, Biological; Postoperative Complications; Sex Factors; Signal Transduction; Vascular Calcification; Ventricular Remodeling
PubMed: 28404735
DOI: 10.1152/physiol.00025.2016 -
JACC. Cardiovascular Imaging Feb 2020
Topics: Aortic Valve Stenosis; Fibrosis; Humans; Myocardium
PubMed: 31326482
DOI: 10.1016/j.jcmg.2019.05.021 -
Journal of the American College of... Jun 2021
Topics: Aortic Valve Stenosis; Humans; Stroke Volume
PubMed: 34082910
DOI: 10.1016/j.jacc.2021.04.027 -
Acta Cardiologica Feb 2016The coexistence of mitral and aortic stenosis is not exceptional. Whereas rheumatic fever is currently plummeting in the Western countries, the incidence of degenerative... (Review)
Review
The coexistence of mitral and aortic stenosis is not exceptional. Whereas rheumatic fever is currently plummeting in the Western countries, the incidence of degenerative disease is inversely increasing. The haemodynamic interactions which may interfere both with the usual echocardiographic parameters and with the invasive assessment may render the diagnosis difficult. The therapeutic challenges raised by this entity should not be underestimated. The increased morbidity and mortality of multivalvular surgery has to be balanced with the risk of a second operation down the line if one valvular involvement, deemed of a lesser importance, is neglected. This complex situation requires the multidisciplinary approach of a heart team involving surgeons, cardiologists, geriatrists if need be and imaging specialists.
Topics: Aortic Valve Stenosis; Heart Valve Prosthesis Implantation; Humans; Incidence; Italy; Mitral Valve Stenosis; Transcatheter Aortic Valve Replacement; Treatment Outcome; Ultrasonography
PubMed: 26853247
DOI: 10.2143/AC.71.1.3132091 -
European Review For Medical and... Dec 2019Aortic valve stenosis (AS) presents a disease during which there are changes of the aortic valve structure that modify the blood structure of patients. The aim of this...
OBJECTIVE
Aortic valve stenosis (AS) presents a disease during which there are changes of the aortic valve structure that modify the blood structure of patients. The aim of this study was to improve the effectiveness of differential diagnostics of aortic stenosis and aortic regurgitation using molecular techniques on both mRNA (RT-PCR) and protein (biochip protein).
PATIENTS AND METHODS
An experimental group (n = 58) consisting of patients with aortic valve stenosis (n = 26) and aortic regurgitation (AR, n = 32) was compared with a control group (n = 35). Both blood serum and valve tissue samples were used for the determination of gene expression specific genes related to inflammatory response (CRP, IL6, IL2R, IL6R, TNFR1, and 2) as well as genes and proteins involved in remodeling of the extracellular matrix (MMP9, TIMP, Emilin-1).
RESULTS
We found that hsCRP and IL6 plasma levels of patients with AS were higher than both controls and patients with AR (mean 5.6 ng/ml). The differences between AS and AR were detected only in mRNA levels of MMP9 and TIMP where increased levels characteristic for AS were found (about 74%, p < 0.01 and 87%, p < 0.001 higher than AR).
CONCLUSIONS
The achieved results could contribute to the improvement of early diagnosis of selected cardiovascular disease in the future and improve the quality of patient's life.
Topics: Aortic Valve Insufficiency; Aortic Valve Stenosis; Female; Humans; Male; Middle Aged; Protein Array Analysis; Real-Time Polymerase Chain Reaction
PubMed: 31858570
DOI: 10.26355/eurrev_201912_19805 -
BMJ (Clinical Research Ed.) Apr 2005
Topics: Aortic Valve Stenosis; Diagnosis, Differential; Early Diagnosis; Humans
PubMed: 15817530
DOI: 10.1136/bmj.330.7495.801 -
Journal of the American College of... Dec 2017The risk and benefit of mechanical interventions in valvular heart disease have been primarily described among patients with normal ejection fraction. The advent of... (Review)
Review
The risk and benefit of mechanical interventions in valvular heart disease have been primarily described among patients with normal ejection fraction. The advent of nonsurgical mechanical interventions for aortic stenosis (transcatheter aortic valve replacement) may alter the risk-benefit ratio for patients who would otherwise be at increased risk for valve surgery. This review describes the epidemiology and pathophysiology of aortic stenosis with heart failure and reduced ejection fraction and summarizes the current registry and clinical trial data applicable to this frequently encountered high-risk group. It concludes with discussion of ongoing trials, new approaches, emerging indications, and a potential clinical algorithm incorporating optimal mechanical intervention for patients with aortic stenosis and concomitant reduced ejection fraction.
Topics: Aortic Valve Stenosis; Heart Failure; Humans; Stroke Volume; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 29241492
DOI: 10.1016/j.jacc.2017.10.040 -
Journal of the American College of... Dec 2020
Topics: Aortic Valve Stenosis; Crime; Diastole; Humans; Registries; Transcatheter Aortic Valve Replacement
PubMed: 33334423
DOI: 10.1016/j.jacc.2020.10.034