Aortic Stenosis: Diagnosis and Treatment

Aortic stenosis is the most common valvular heart disease in the United States, and it affects up to 3.7% of the general population. Atherosclerosis results in progressive calcification of the aortic valve, leading to valve narrowing. Aortic stenosis is more common in older adults and men and in those with bicuspid aortic valves or cardiovascular risk factors. Classic symptoms of aortic stenosis include exertional angina, dyspnea, syncope, presyncope, and symptoms of heart failure. Patients may present with atypical symptoms (eg, fatigue, exercise intolerance), which may be mistaken for other cardiopulmonary conditions or attributed to aging. Transthoracic echocardiography is the preferred test for diagnosis because it can classify the severity of aortic stenosis. Asymptomatic patients with aortic stenosis may be monitored with echocardiography every 3 to 5 years for mild stenosis, 1 to 2 years for moderate stenosis, and 6 to 12 months for severe stenosis. No specific treatment prevents the need for aortic valve replacement or reverses aortic stenosis. Aortic valve replacement is indicated in patients with symptomatic severe aortic stenosis and in a subset of those with asymptomatic severe stenosis. There is no difference in mortality between transcatheter aortic valve replacement and surgical valve replacement.