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Evolving perspectives on aortic stenosis: the increasing importance of evaluating the right ventricle before aortic

Vitaliy Androshchuk1, Omar Chehab1, Joshua Wilcox2

  • 1School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom.

Frontiers in Cardiovascular Medicine
|January 23, 2025
PubMed

Insights

Aortic stenosis (AS) can affect the right ventricle (RV), leading to poor outcomes after aortic valve replacement. Early RV assessment is crucial for risk stratification and potentially improving intervention timing in AS patients.

Area of Science:

  • Cardiology
  • Cardiovascular Physiology
  • Cardiac Surgery

Background:

  • Aortic stenosis (AS) traditionally impacts the left ventricle (LV).
  • Progressive pressure overload in AS can cause right ventricular (RV) remodeling and dysfunction.
  • The clinical significance of RV changes in AS has been historically underestimated.

Purpose of the Study:

  • To review RV physiology and mechanisms of RV impairment in AS.
  • To discuss multimodality assessment of RV structure and function in AS.
  • To highlight the impact of RV dysfunction on outcomes after aortic valve replacement (AVR).

Main Methods:

  • Literature review of RV physiology in AS.
  • Discussion of RV assessment techniques (echocardiography, MRI, CT).
  • Analysis of clinical data linking RV status to outcomes post-AVR.

Main Results:

  • RV dilatation and dysfunction are associated with increased risk in AS patients undergoing AVR.
  • Quantitative RV assessment aids in risk stratification for AS.
  • RV impairment negatively impacts clinical outcomes following AVR.

Conclusions:

  • RV changes are a critical, often underappreciated, aspect of AS pathophysiology.
  • Comprehensive RV assessment is vital for managing AS patients.
  • Understanding RV involvement may refine timing for intervention and improve AVR outcomes.

Keywords:
aortic stenosisaortic valve replacementcardiovascular riskpulmonary hypertensionright ventricle

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