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Related Concept Videos

  • Education
  • Specialist Studies In Education
  • Special Education And Disability
  • Valvular Heart Disease: A Perspective On The Asymptomatic Patient With Severe Valvular Aortic Stenosis.
  • Education
  • Specialist Studies In Education
  • Special Education And Disability
  • Valvular Heart Disease: A Perspective On The Asymptomatic Patient With Severe Valvular Aortic Stenosis.

    • Related Experiment Videos

    Valvular heart disease: a perspective on the asymptomatic patient with severe valvular aortic stenosis.

    Shahbudin H Rahimtoola1

    • 1Griffith Center, Division of Cardiovascular Medicine, Department of Medicine, LAC+USC Medical Center, University of Southern California, 2025 Zonal Avenue, GNH 7131, Los Angeles, CA 90033, USA. rahimtoo@usc.edu

    European Heart Journal
    |June 25, 2008

    View abstract on PubMed

    Summary
    This summary is machine-generated.

    Severe calcific valvular aortic stenosis (AS) in asymptomatic older patients often lacks strong evidence for primary aortic valve replacement (AVR). Current guidelines recommend AVR primarily for those with left ventricular dysfunction or exercise-induced symptoms.

    Related Experiment Videos

    Area of Science:

    • Cardiology
    • Valvular Heart Disease
    • Geriatric Cardiology

    Background:

    • Severe calcific valvular aortic stenosis (AS) presents a clinical challenge, particularly in asymptomatic older patients.
    • Recent guidelines from the European Society of Cardiology (ESC) and the American College of Cardiology/American Heart Association (ACC/AHA) address management strategies.
    • The evidence base for intervention in this patient group remains limited.

    Purpose of the Study:

    • To provide a broad perspective on the management of asymptomatic patients with severe calcific valvular aortic stenosis.
    • To review current guideline recommendations for primary aortic valve replacement (AVR) in this population.
    • To highlight the level of evidence supporting these recommendations.

    Main Methods:

    • Review of European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines published in 2006 and 2007.
    • Analysis of recommendations for primary aortic valve replacement (AVR) in asymptomatic severe aortic stenosis.
    • Assessment of the evidence level (Class I, IIa, IIb) supporting guideline recommendations.

    Main Results:

    • Class I recommendation for primary AVR in asymptomatic severe AS is limited to patients with resting left ventricular dysfunction or symptoms on exercise testing.
    • Indications for AVR in Class IIa and IIb were also provided.
    • A significant proportion of recommendations (Classes I and II) were based on Level of Evidence C, indicating limited empirical support.

    Conclusions:

    • Current guidelines offer specific, albeit evidence-limited, indications for primary AVR in asymptomatic severe AS.
    • The management of asymptomatic severe AS in older patients requires careful consideration of guideline recommendations and the level of supporting evidence.
    • Further research is needed to strengthen the evidence base for AVR in asymptomatic severe AS.