Natural History of Moderate Aortic Stenosis with Preserved and Low Ejection Fraction

Mann, Tomer; Loewenstein, Itamar; Assa, Eyal Ben; Topilsky, Yan

doi:10.1016/j.echo.2021.02.014

Cited by 19 publications

(20 citation statements)

References 26 publications

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“…The Tromsø Study prospectively studied 3273 individuals with serial echocardiography over 14 years and found that the estimated point prevalence of AS steadily rose with age: 0.2%, 1.3%, 3.9% and 9.8% for those aged 50–59, 60–69, 70–79, and 80–89 years 18. A more recent study of all patients who underwent echocardiogram at a single medical centre found that 2.4% of adults had moderate AS (mean age 78) 19…”

Section: Epidemiology and Progression Of Moderate Asmentioning

confidence: 99%

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Moderate aortic stenosis: culprit or bystander?

et al. 2022

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Non-rheumatic aortic stenosis (AS) is among the most common valvular diseases in the developed world. Current guidelines support aortic valve replacement (AVR) for severe symptomatic AS, which carries high morbidity and mortality when left untreated. In contrast, moderate AS has historically been thought to be a benign diagnosis for which the potential benefits of AVR are outweighed by the procedural risks. However, emerging data demonstrating the substantial mortality risk in untreated moderate AS and substantial improvements in periprocedural and perioperative mortality with AVR have challenged the traditional risk/benefit paradigm. As such, an appraisal of the contemporary data on morbidity and mortality associated with moderate AS and appropriate timing of valvular intervention in AS is warranted. In this review, we discuss the current understanding of moderate AS, including the epidemiology, current surveillance and management guidelines, clinical outcomes, and future studies.

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Section: Epidemiology and Progression Of Moderate Asmentioning

confidence: 99%

“… 18 A more recent study of all patients who underwent echocardiogram at a single medical centre found that 2.4% of adults had moderate AS (mean age 78). 19 …”

Section: Epidemiology and Progression Of Moderate Asmentioning

confidence: 99%

Moderate aortic stenosis: culprit or bystander?

et al. 2022

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“…Nonetheless, the current guidelines do not recommend aortic valve replacement when AS severity is moderate at rest and/or on low‐dose dobutamine stress echocardiogram 54 . It has been suggested that relieving AS at an earlier stage of the disease might be beneficial, particularly in patients with HFrEF, because each progressive increase in AS severity imposes a certain amount of pressure on the LV 131,132 . Several ongoing trials are assessing the use of TAVI in patients with moderate AS.…”

Section: Current Therapeutic Optionsmentioning

confidence: 99%

“…54 It has been suggested that relieving AS at an earlier stage of the disease might be beneficial, particularly in patients with HFrEF, because each progressive increase in AS severity imposes a certain amount of pressure on the LV. 131,132 Several ongoing trials are assessing the use of TAVI in patients with moderate AS. The Transcatheter Aortic Valve Replacement to UNload the Left Ventricle in Patients With ADvanced Heart Failure (TAVR-UNLOAD) trial is assessing the efficacy and safety of transfemoral TAVI in patients with moderate AS, HF, and impaired LVEF (NCT 02661451).…”

Section: Early Intervention In Patients With Moderate Aortic Stenosismentioning

confidence: 99%

Determinants and treatments of heart failure after transcatheter aortic valve implantation: moving up a notch

et al. 2023

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Transcatheter aortic valve implantation (TAVI) has become an alternative to surgical aortic valve replacement for patients with symptomatic severe aortic stenosis in elderly and comorbid population. Significant improvement in heart function has been observed in patients undergoing TAVI, but numerous patients are readmitted to hospital for heart failure (HF). Moreover, repeat HF hospitalization is strongly associated with an adverse prognosis and increases the financial burden of health care. Although studies have identified pre-existing and post-procedural factors that contribute to HF hospitalization after TAVI, there is a paucity of data regarding optimal post-procedural pharmacological treatments. This review aims to provide an overview of the current understanding of mechanisms, determinants, and potential treatments of HF following TAVI. We first review the pathophysiology of left ventricular (LV) remodelling, coronary microcirculation disorder, and endothelial dysfunction in patients with aortic stenosis and then examine the impact of TAVI on these conditions. We then present evidence of various factors and complications that may interplay with LV remodelling and contribute to HF events after TAVI. Next, we describe the triggers and predictors of early and late HF rehospitalizations following TAVI. Lastly, we discuss the potential of conventional pharmacological treatments, including renin-angiotensin blockers, beta-blockers, and diuretics in TAVI patients. The paper explores the potential of newer drugs, including sodium-glucose co-transporter 2 inhibitors, anti-inflammatory drugs, and ion supplementation. Comprehensive knowledge in this field may aid in recognizing successful existing therapies, developing effective new treatments, and establishing dedicated patient care strategies during follow-up after TAVI.

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“…Some patients, for example, experience a reduction in left ventricular ejection fraction as a result of the aforementioned pathophysiologic changes related to progressive AS. Multiple reports exist describing increased mortality in patients who develop heart failure with reduced ejection fraction (HFrEF) in the setting of moderate AS 8,9,10,11 . It is unclear whether it is the aortic valvular obstruction or the reduced systolic function that is contributing to the poor outcomes in this population, however.…”

mentioning

confidence: 99%

The Dilemma of Moderate Aortic Stenosis in Patients With Heart Failure and Reduced Ejection Fraction: Are We Waiting Too Long to Intervene, or Should We Wait for More Evidence?

Cormican

Czerny

Ramakrishna

2022

Journal of Cardiothoracic and Vascular Anesthesia

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Natural History of Moderate Aortic Stenosis with Preserved and Low Ejection Fraction

Cited by 19 publications

References 26 publications

Moderate aortic stenosis: culprit or bystander?

Moderate aortic stenosis: culprit or bystander?

Determinants and treatments of heart failure after transcatheter aortic valve implantation: moving up a notch

The Dilemma of Moderate Aortic Stenosis in Patients With Heart Failure and Reduced Ejection Fraction: Are We Waiting Too Long to Intervene, or Should We Wait for More Evidence?

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