Aortic stenosis: diagnosis and management

Zakkar, Mustafa; Bryan, Alan J.; Angelini, Gianni

doi:10.1136/bmj.i5425

Cited by 28 publications

(33 citation statements)

References 19 publications

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“…Aortic stenosis (AS) is the most common valvular heart disease in the elderly in Western countries [1,2], with an estimated prevalence of 5-7% in the general population over 65 years [3]. According to the current guidelines, intervention is recommended for patients with symptomatic or rapidly progressing severe aortic stenosis and for asymptomatic patients with significant decline of the left ventricular (LV) ejection fraction (EF) < 50% [4].…”

Section: Introductionmentioning

confidence: 99%

Biomarkers Associated with Mortality in Aortic Stenosis: A Systematic Review and Meta-Analysis

et al. 2021

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The optimal timing of aortic valve replacement (AVR) remains controversial. Several biomarkers reflect the underlying pathophysiological processes in aortic stenosis (AS) and may be of use as mortality predictors. The aim of this systematic review and meta-analysis is to evaluate the blood biomarkers utilised in AS and assess whether they associate with mortality. PubMed and Embase were searched for studies reporting baseline biomarker level and mortality outcomes in patients with AS. A total of 83 studies met the inclusion criteria and were systematically reviewed. Of these, 21 reporting brain natriuretic peptide (BNP), N-terminal pro B-type natriuretic peptide (NT-proBNP), Troponin and Galectin-3 were meta-analysed. Pooled analysis demonstrated that all-cause mortality was significantly associated with elevated baseline levels of BNP (HR 2.59; 95% CI 1.95–3.44; p < 0.00001), NT-proBNP (HR 1.73; 95% CI 1.45–2.06; p = 0.00001), Troponin (HR 1.65; 95% CI 1.31–2.07; p < 0.0001) and Galectin-3 (HR 1.82; 95% CI 1.27–2.61; p < 0.001) compared to lower baseline biomarker levels. Elevated levels of baseline BNP, NT-proBNP, Troponin and Galectin-3 were associated with increased all-cause mortality in a population of patients with AS. Therefore, a change in biomarker level could be considered to refine optimal timing of intervention. The results of this meta-analysis highlight the importance of biomarkers in risk stratification of AS, regardless of symptom status.

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Section: Introductionmentioning

confidence: 99%

Biomarkers Associated with Mortality in Aortic Stenosis: A Systematic Review and Meta-Analysis

et al. 2021

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“…Aortic valve stenosis is the leading heart valve disease in developing countries with an estimated prevalence of up to 3% in patients over 70 years. 1 Today, transcatheter aortic valve replacement (TAVI) is becoming the treatment of choice for patients with aortic valve stenosis and high to intermediate operative risk. Recent studies demonstrated similar and superior results of the transfemoral TAVI approach compared to surgical replacement in patents with low operative risk.…”

Section: Introductionmentioning

confidence: 99%

Dynamics of cerebral oxygenation during rapid ventricular pacing and its impact on outcome in transfemoral transcatheter aortic valve implantation

Seppelt

Mas-Peiró

Rosa

et al. 2020

Cathet Cardio Intervent

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Background: Cerebral O 2 saturation (ScO 2) reflects cerebral perfusion and can be measured noninvasively by near-infrared spectroscopy (NIRS). Objectives: In this pilot study, we describe the dynamics of ScO 2 during TAVI in nonventilated patients and its impact on procedural outcome. Methods and Results: We measured ScO 2 of both frontal lobes continuously by NIRS in 50 consecutive analgo-sedated patients undergoing transfemoral TAVI (female 58%, mean age 80.8 years). Compared to baseline ScO 2 dropped significantly during RVP (59.3% vs. 53.9%, p < .01). Five minutes after RVP ScO 2 values normalized (post RVP 62.6% vs. 53.9% during RVP, p < .01; pre 61.6% vs. post RVP 62.6%, p = .53). Patients with an intraprocedural pathological ScO 2 decline of >20% (n = 13) had higher EuroSCORE II (3.42% vs. 5.7%, p = .020) and experienced more often delirium (24% vs. 62%, p = .015) and stroke (0% vs. 23%, p < .01) after TAVI. Multivariable logistic regression revealed higher age and large ScO 2 drops as independent risk factors for delirium. Conclusions: During RVP ScO 2 significantly declined compared to baseline. A ScO 2 decline of >20% is associated with a higher incidence of delirium and stroke and a valid cutoff value to screen for these complications. NIRS measurement during TAVI procedure may be an easy to implement diagnostic tool to detect patients at high risks for cerebrovascular complications and delirium.

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“…Aortic stenosis (AS) is the most common valvular heart disease in the developed world, with a prevalence in Europe of 1–3% 1. With an ageing population, the prevalence of AS is likely to increase.…”

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confidence: 99%

Patient-prosthesis mismatch following aortic valve replacement

Bilkhu

Jahangiri

Otto

2019

Heart

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Patient-prosthesis mismatch (PPM) occurs when an implanted prosthetic valve is too small for the patient; severe PPM is defined as an indexed effective orifice area (iEOA) <0.65 cm2/m2 following aortic valve replacement (AVR). This review examines articles from the past 10 years addressing the prevalence, outcomes and options for prevention and treatment of PPM after AVR. Prevalence of PPM ranges from 8% to almost 80% in individual studies. PPM is thought to have an impact on mortality, mainly in patients with severe PPM, although severe PPM accounts for only 10–15% of cases. Outcomes of patients with moderate PPM are not significantly different to those without PPM. PPM is associated with higher rates of perioperative stroke and renal failure and lack of left ventricular mass regression. Predictors include female sex, older age, hypertension, diabetes, renal failure and higher surgical risk score. PPM may be a marker of comorbidity rather than a risk factor for adverse outcomes. PPM should be suspected in patients with persistent cardiac symptoms after AVR when there is high prosthetic valve velocity or gradient and a small calculated effective orifice area. After exclusion of other causes of increased transvalvular gradient, re-intervention may be considered if symptoms persist and are unresponsive to medical therapy. However, this decision needs to consider the available options to relieve PPM and whether expected benefits justify the risk of intervention. The only effective intervention is redo surgery with implantation of a larger valve and/or annular enlargement. Therefore, focus needs to be on prevention.

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Aortic stenosis: diagnosis and management

Cited by 28 publications

References 19 publications

Biomarkers Associated with Mortality in Aortic Stenosis: A Systematic Review and Meta-Analysis

Biomarkers Associated with Mortality in Aortic Stenosis: A Systematic Review and Meta-Analysis

Dynamics of cerebral oxygenation during rapid ventricular pacing and its impact on outcome in transfemoral transcatheter aortic valve implantation

Patient-prosthesis mismatch following aortic valve replacement

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