Contemporary Workup and Management of Asymptomatic Patients with Severe Aortic Stenosis

AbstractPurpose of reviewAppropriate management of asymptomatic patients with severe aortic stenosis (AS) is increasingly debated given recent improvements in options for aortic valve replacement (AVR). The goal of this review is to provide an updated approach to evaluation and management of patients with asymptomatic severe AS and to discuss the rationale for early AVR.Recent findingsRegistry data, retrospective studies, and one small randomized controlled clinical trial suggest a mortality benefit to AVR before symptom onset, although larger randomized trials are needed given potential biases of observational data. Other promising approaches to risk stratification of asymptomatic adults with severe AS include cardiac biomarkers (such as serum B-type natriuretic peptide levels), left ventricular global longitudinal strain, and myocardial fibrosis detected on cardiac magnetic resonance imaging.SummaryRoutine close clinical follow-up, periodic imaging, patient education, and shared decision-making are essential in caring for asymptomatic patients with severe AS but there is not yet enough evidence to support early AVR in most patients. Ongoing clinical trials and evaluation of biomarkers will illuminate whether intervention before symptom onset will improve the length or quality of life in adults with severe AS.
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research

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Authors: Erbel R Abstract The progress in cardiology during the last 50 years can best be studied by looking at the diagnostics and treatment of patients with aortic valve stenosis. Previously, the clinical examination, electrocardiography (ECG) and chest X‑ray were used before heart catheterization, which included a transseptal puncture to complete the indications for surgery in young patients. Nowadays, echocardiography, often combined with a dobutamine stress test, is the primary diagnostic tool to which computed tomography for quantification of valve calcification and cardiac magnetic resonance...
Source: Herz - Category: Cardiology Tags: Herz Source Type: research
Transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with severe aortic stenosis (AS). Cardiovascular magnetic resonance imaging (CMR) provides reliable and reproducible estimat...
Source: Journal of Cardiovascular Magnetic Resonance - Category: Radiology Authors: Tags: Research Source Type: research
ConclusionBoth TTR ‐ and AL‐CA can accompany severe AS. Parameters solely based on ECG and echocardiography allow for the identification of the majority of CA‐AS. In the present cohort, CA did not significantly worsen prognosis 15.3 months after TAVR.
Source: European Journal of Heart Failure - Category: Cardiology Authors: Tags: Research Article Source Type: research
Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement in selected patients with severe symptomatic aortic stenosis (AS) and high surgical risk. The planning and follow-up of TAVI requires an array of imaging techniques, each has advantages and limitations. Echocardiography and multidetector computer tomography (MDCT) have established applications in patient selection and procedure guidance, but are limited in some patients. TAVI applications of cardiovascular magnetic resonance imaging (CMRI) are emerging.
Source: Clinical Radiology - Category: Radiology Authors: Tags: Review Source Type: research
AbstractPurpose of ReviewAortic stenosis is the most prevalent valvular heart disease. The purpose of this paper is to review the epidemiology, pathophysiology, and diagnosis of aortic valve stenosis.Recent FindingsThe diagnosis of aortic stenosis has evolved over time. Originally diagnosed with cardiac catheterization and echocardiography, more advance imaging techniques including computed tomography, magnetic resonance imaging, and 3D printing have improved our understanding of the physiology and hemodynamic effects of aortic stenosis.SummaryValvular heart disease affects a broad patient population, and the most common f...
Source: Current Cardiovascular Risk Reports - Category: Cardiology Source Type: research
Conclusions: In patients with severe aortic stenosis, a larger end-diastolic LV volume, impaired LV global longitudinal strain, and larger LV fibrosis extent can predict the development of pulmonary hypertension. PMID: 31652546 [PubMed - in process]
Source: Medicina (Kaunas) - Category: Universities & Medical Training Authors: Tags: Medicina (Kaunas) Source Type: research
AbstractPurpose of ReviewMultimodality imaging is integral for diagnosis, procedural guidance, and follow-up of patients undergoing transcatheter aortic valve replacement (TAVR). In this review, we provide an overview of the role of each imaging modality and highlight technical considerations and pitfalls. We also address current controversies and new developments in the field.Recent FindingsEchocardiography remains the primary imaging modality for diagnosis of aortic stenosis and intraprocedural guidance for TAVR, but computed tomography (CT) imaging has supplanted echocardiography for annular sizing and access site evalu...
Source: Current Cardiology Reports - Category: Cardiology Source Type: research
This article explores the clinical utility of CMR imaging evaluation.
Source: Magnetic Resonance Imaging Clinics of North America - Category: Radiology Authors: Source Type: research
This study aimed to report a case of hypertrophic obstructive cardiomyopathy causing an illusion of aortic stenosis on imaging. Patient concerns: A 71-year-old woman presented with chest tightness after activity for 1 year and coughing for 2 months. A systolic 3/6 grade murmur was found in the third intercostals of the left border of sternum. Transthoracic echocardiography, transesophageal echocardiography, and magnetic resonance imaging (MRI) were all suggestive of aortic stenosis and left ventricular outflow tract stenosis. Diagnosis: The patient was diagnosed with “severe aortic stenosis (bicuspid deformity)...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Publication date: Available online 10 November 2018Source: The Annals of Thoracic SurgeryAuthor(s): Tania Giovannetti, Catherine C. Price, Molly Fanning, Steven Messé, Sarah J. Ratcliffe, Abigail Lyon, Scott E. Kasner, Gregory Seidel, Joseph E. Bavaria, Wilson Y. Szeto, W. Clarke Hargrove, Michael A. Acker, Thomas F. Floyd, DENOVO InvestigatorsAbstractBackgroundAortic valve replacement (AVR) for calcific aortic stenosis is associated with high rates of perioperative stroke and “silent” cerebral infarcts on diffusion-weighted magnetic resonance imaging (MRI), but cognitive outcomes in elderly AVR patients...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
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