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Managing Patients With Moderate Aortic Stenosis

Jan Stassen1, See Hooi Ewe2, Stephan M Pio3

  • 1Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Jessa Hospital, Hasselt, Belgium.

JACC. Cardiovascular Imaging
|March 7, 2023
PubMed

Insights

Current guidelines suggest monitoring moderate aortic stenosis (AS) patients, but new research links AS to increased cardiovascular risks. This review clarifies diagnosis and management, exploring early aortic valve replacement (AVR) benefits.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Valvular Heart Disease

Background:

  • Current guidelines recommend clinical surveillance for moderate aortic stenosis (AS) with consideration for aortic valve replacement (AVR) only if coronary revascularization is indicated.
  • Recent studies indicate moderate AS is linked to increased cardiovascular events and mortality, but the cause (comorbidities vs. AS itself) remains unclear.
  • Optimal follow-up strategies and patient selection for early AVR in moderate AS are not well-defined.

Purpose of the Study:

  • To provide a comprehensive review of current literature on moderate AS.
  • To present a diagnostic algorithm for moderate AS, addressing discordant grading.
  • To discuss the role of the ventricle in AS and how multimodality imaging aids risk stratification.

Main Methods:

  • Review of published reports on moderate aortic stenosis.
  • Development of a diagnostic algorithm for moderate AS.
  • Discussion of multimodality imaging for left ventricular assessment and risk stratification.
  • Summary of current management evidence and ongoing trials for AVR in moderate AS.

Main Results:

  • A diagnostic algorithm is proposed to aid in correctly identifying moderate AS, particularly in cases of discordant grading.
  • The review emphasizes AS as a disease involving both the aortic valve and the ventricle.
  • Multimodality imaging is highlighted as a tool for assessing left ventricular remodeling and improving risk stratification.

Conclusions:

  • Accurate diagnosis of moderate AS is crucial, especially when grading is discordant.
  • Understanding the ventricular component of AS and utilizing advanced imaging can refine risk assessment.
  • Further research and ongoing trials are essential to define optimal management strategies, including the role of early AVR in moderate AS.

Keywords:
heart failure with reduced ejection fractionleft ventricular remodelingmoderate aortic stenosistranscatheter aortic valve replacement

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