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Integrating hemodynamics with ventricular and valvular remodeling in aortic stenosis. A paradigm shift in therapeutic

Gregory S Pavlides1, Yannis S Chatzizisis1, Thomas R Porter1

  • 1The University of Nebraska Medical Center, Omaha, Nebraska.

American Heart Journal
|August 15, 2022
PubMed

Insights

Left ventricular remodeling and other factors are crucial for aortic valve stenosis (AS) outcomes, beyond just hemodynamics. Integrating these factors with imaging and biomarkers improves treatment decisions and patient prognosis in AS.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Biomarkers

Background:

  • Aortic valve stenosis (AS) management traditionally relies on hemodynamic assessment.
  • Hemodynamics and symptoms alone may not fully predict prognosis or guide intervention in AS.
  • Left ventricular and valvular/vascular remodeling are critical prognostic factors in AS.

Purpose of the Study:

  • To review a novel approach integrating remodeling factors into AS management.
  • To propose a Heart Team decision-making algorithm for moderate to severe AS.
  • To improve patient selection for interventional treatment and enhance outcomes.

Main Methods:

  • Review of novel laboratory and imaging techniques for detecting remodeling.
  • Inclusion of biomarkers, echocardiography, cardiac magnetic resonance, and CT imaging.
  • Development of a simple algorithm for Heart Team decision making.

Main Results:

  • Remodeling changes in AS do not consistently correlate with hemodynamic severity.
  • Novel imaging and laboratory techniques can detect important remodeling.
  • Integrating remodeling factors improves patient selection and outcomes.

Conclusions:

  • A comprehensive approach considering hemodynamics and remodeling is essential for AS management.
  • The proposed Heart Team algorithm aids in optimizing therapeutic decisions.
  • This integrated strategy enhances patient outcomes in moderate to severe AS.

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