Staging Cardiac Damage in Patients With Asymptomatic Aortic Valve Stenosis

Tastet, Lionel; Tribouilloy, Christophe; Maréchaux, Sylvestre; Vollema, E. Mara; Delgado, Victoria; Salaün, Erwan; Shen, Mylène; Capoulade, Romain; Clavel, Marie‐Annick; Arsenault, Marie; Bédard, Élisabeth; Bernier, Martin; Beaudoin, Jonathan; Narula, Jagat; Lancellotti, Patrizio; Bax, Jeroen J.; Généreux, Philippe; Pîbarot, Philippe

doi:10.1016/j.jacc.2019.04.065

Cited by 161 publications

(75 citation statements)

References 30 publications

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“…Similar results were reported from other recent studies 36–38. Therefore, the cut-off value of the LVEF was raised from 50% to 60% to improve the identification of subclinical LV dysfunction in a recent paper reporting the staging cardiac damage in asymptomatic patients with severe AS 39. We also showed that the patients with a >10% decline of LVEF at the 1-year follow-up echocardiography had a worse clinical outcomes compared with those without decline in LVEF regardless of the baseline LVEF 40.…”

Section: Management Of Asymptomatic Patients With Severe Assupporting

confidence: 82%

Contemporary issues in severe aortic stenosis: review of current and future strategies from the Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis registry

Taniguchi

Morimoto

Takeji

et al. 2020

Heart

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Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis (CURRENT AS) registry was a large Japanese multicentre retrospective registry of consecutive patients with severe aortic stenosis (AS) before introduction of transcatheter aortic valve implantation. We sought to overview the data from the CURRENT AS registry to discuss the three major contemporary issues related to clinical practice in patients with severe AS: (1) under-referral/underuse of surgical aortic valve replacement (SAVR) in symptomatic patients with severe AS, (2) management of asymptomatic patients with severe AS and (3) management of patients with low-gradient severe aortic stenosis (LG-AS). First, despite the dismal prognosis of symptomatic patients with severe AS, SAVR, including those performed during follow-up, was reported to be underused. In the CURRENT AS registry, overall 53% of symptomatic patients underwent aortic valve replacement (AVR) during follow-up. Second, we reported that compared with conservative strategy, initial AVR strategy was associated with lower risk of all-cause death and heart failure hospitalisation in asymptomatic patients with severe AS. Although current recommendations for AVR are mainly dependent on the patient symptoms, some patients may not complain of any symptom because of their sedentary lifestyle. We also reported several important objective factors associated with worse clinical outcomes in asymptomatic patients with severe AS for risk stratification. Finally, initial AVR strategy was associated with better long-term clinical outcomes than conservative strategy in both patients with high-gradient AS and patients with LG-AS. The favourable effect of initial AVR strategy was also seen in patients with LG-AS with left ventricular ejection fraction of ≥50%.

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Section: Management Of Asymptomatic Patients With Severe Assupporting

confidence: 82%

Contemporary issues in severe aortic stenosis: review of current and future strategies from the Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis registry

Taniguchi

Morimoto

Takeji

et al. 2020

Heart

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“…Previously, we proposed and validated a new scheme for staging the extent of cardiac damage associated with AS. 14,15 Stage 1 corresponds to damage at the level of the left ventricle; Stage 2: left atrium and mitral valve; Stage 3: pulmonary arterial circulation and tricuspid valve; and Stage 4: right ventricular level. Several echocardiographic parameters and criteria have been proposed for each stage to classify patients with respect to the extent of cardiac damage.…”

Section: Cardiac Damage Staging In Asmentioning

confidence: 99%

“…This staging approach has the potential to improve risk stratification before AVR and also to determine the optimal timing for intervention in patients with asymptomatic severe AS. 14,15 Given that a low-flow state may result from damage at any of the 4 cardiac chambers and constitutes a marker of cardiac decompensation, we recently proposed to add, in Stage 4, the presence of moderate/severe low-flow state (stroke-volume index < 30 mL/m 2 ). 14 The results of the current study by Alkhalil et al 11 provide an argument in favour of earlier intervention before deterioration of LV pump function.…”

Section: Cardiac Damage Staging In Asmentioning

confidence: 99%

“…14,15 Given that a low-flow state may result from damage at any of the 4 cardiac chambers and constitutes a marker of cardiac decompensation, we recently proposed to add, in Stage 4, the presence of moderate/severe low-flow state (stroke-volume index < 30 mL/m 2 ). 14 The results of the current study by Alkhalil et al 11 provide an argument in favour of earlier intervention before deterioration of LV pump function. Some recent studies also suggest that the current cutoff value of LVEF (< 50%) proposed in the guidelines to identify subclinical LV dysfunction in AS is too low and that early AVR…”

Section: Cardiac Damage Staging In Asmentioning

confidence: 99%

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Importance of Flow in Risk Stratification of Aortic Stenosis

Guzzetti

Clavel

2020

Canadian Journal of Cardiology

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“…Aortic stenosis (AS) is the most common valvular heart disease in adults, with an increasing prevalence in the ageing population 1. Calciﬁc AS is a complex disease that includes changes in the valve and myocardium 2. The response of the left ventricle (LV) to pressure overload in AS ultimately contributes to symptom occurrence, and its consequences impact management and outcomes.…”

Section: Introductionmentioning

confidence: 99%

Role of advanced left ventricular imaging in adults with aortic stenosis

Călin

Mateescu

Popescu

et al. 2020

Heart

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This review focuses on the available data regarding the utility of advanced left ventricular (LV) imaging in aortic stenosis (AS) and its potential impact for optimising the timing of aortic valve replacement. Ejection fraction is currently the only LV parameter recommended to guide intervention in AS. The cut-off value of 50%, recommended for decision-making in asymptomatic patients with AS, is currently under debate. Several imaging parameters have emerged as predictors of disease progression and clinical outcomes in this setting. Global longitudinal LV strain by speckle tracking echocardiography is useful for risk stratification of asymptomatic patients with severe AS and preserved LV ejection fraction.

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Staging Cardiac Damage in Patients With Asymptomatic Aortic Valve Stenosis

Cited by 161 publications

References 30 publications

Contemporary issues in severe aortic stenosis: review of current and future strategies from the Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis registry

Contemporary issues in severe aortic stenosis: review of current and future strategies from the Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis registry

Importance of Flow in Risk Stratification of Aortic Stenosis

Role of advanced left ventricular imaging in adults with aortic stenosis

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