Risk stratification and management of aortic stenosis with concomitant left ventricular dysfunction

Area of Science:

• Cardiology
• Cardiac Surgery
• Heart Valve Disease

Background:

• Aortic stenosis is a prevalent clinical issue.
• Left ventricular (LV) dysfunction typically follows symptom onset in aortic stenosis.
• Patients with both severe aortic stenosis and LV dysfunction represent a challenging subgroup.

Purpose of the Study:

• To outline the management strategies for patients with aortic stenosis and LV dysfunction.
• To discuss risk stratification and surgical decision-making in this patient population.
• To highlight the role of contractile reserve assessment and potential future therapies.

Main Methods:

• Review of clinical management approaches for aortic stenosis with LV dysfunction.
• Emphasis on risk stratification, including assessment of contractile reserve via dobutamine challenge.
• Discussion of current treatment paradigms and emerging interventional options.

Main Results:

• Patients with aortic stenosis, LV dysfunction, and low transvalvular gradients are high-risk, especially if contractile reserve is absent.
• Surgical valve replacement is the only proven therapy.
• Even high-risk patients without contractile reserve may benefit from surgery.

Conclusions:

• Surgical valve replacement remains the cornerstone for managing severe aortic stenosis with LV dysfunction.
• Risk stratification, particularly assessing contractile reserve, is crucial for treatment decisions.
• Percutaneous aortic valve interventions represent a promising future avenue for high-risk patients.