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Markers of left ventricular decompensation in aortic stenosis

Calvin W L Chin1, Vassilis Vassiliou, William S A Jenkins

  • 1BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.

Expert Review of Cardiovascular Therapy
|May 29, 2014
PubMed

Insights

Calcified aortic stenosis leads to left ventricular hypertrophy and heart failure. Novel biomarkers may improve timing for aortic valve replacement, optimizing patient outcomes.

Area of Science:

  • Cardiology
  • Biomarkers
  • Heart Failure

Background:

  • Calcified aortic stenosis (CAS) causes left ventricular hypertrophy (LVH) as an adaptive response.
  • LVH can progress to ventricular decompensation and heart failure.
  • Current guidelines for aortic valve replacement (AVR) rely on symptoms or reduced ejection fraction (EF <50%).

Purpose of the Study:

  • To review the pathophysiology of LVH in CAS and its transition to heart failure.
  • To explore novel biomarkers for identifying this transition.
  • To guide optimal timing for AVR.

Main Methods:

  • Literature review of pathophysiology.
  • Analysis of current guidelines for AVR.
  • Exploration of emerging biomarkers.

Main Results:

  • Symptoms and reduced ejection fraction are imperfect indicators for AVR timing.
  • LVH progression to heart failure is a critical determinant for intervention.
  • Novel biomarkers show potential for earlier and more accurate detection of decompensation.

Conclusions:

  • Early identification of decompensation is crucial for timely AVR.
  • Novel biomarkers may offer improved prognostic value over current methods.
  • Optimizing AVR timing can improve outcomes in patients with severe aortic stenosis.

Keywords:
aortic stenosiscardiac MRIechocardiographyleft ventricular decompensationleft ventricular hypertrophymyocardial T1 mappingmyocardial fibrosismyocyte deathtissue Doppler imaging

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