Aortic stenosis - pathogenesis, prediction of progression, and percutaneous intervention.

Aortic stenosis - pathogenesis, prediction of progression, and percutaneous intervention. J R Coll Physicians Edinb. 2017 Jun;47(2):172-175 Authors: Natarajan D, Prendergast B Abstract Aortic stenosis is common and an important cause of morbidity and mortality. Prevalence will increase significantly in forthcoming decades as a function of the ageing population; treatment by means of surgery or percutaneous intervention is expensive. Epidemiological, mechanistic and interventional studies are therefore vital to determine optimal and innovative treatments and their funding. Recent studies suggest that aortic stenosis is not a passive degenerative disease, but an active process involving several pathways, including lipid infiltration, chronic inflammation, fibrosis formation, osteoblast activation, and active valve mineralisation. Despite similarities with atherosclerosis, randomised statin trials proved negative in aortic stenosis, underlining the need to explore alternative pathophysiological pathways. Left ventricular hypertrophy in response to pressure overload in aortic stenosis is initially adaptive but ultimately decompensates, leading to progressive left ventricular impairment, symptoms and adverse cardiovascular events. This transition is driven primarily by myocyte death and myocardial fibrosis. Cardiac magnetic resonance imaging can visualise and quantify myocardial fibrosis and may provide additional and independent prognost...
Source: Journal of the Royal College of Physicians of Edinburgh - Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research