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Review
. 2018 Dec;104(24):2067-2076.
doi: 10.1136/heartjnl-2017-312304. Epub 2018 Jul 20.

Timing of intervention in aortic stenosis: a review of current and future strategies

Russell James Everett  1 , Marie-Annick Clavel  2 , Philippe Pibarot  2 , Marc Richard Dweck  1
Affiliations
Review

Timing of intervention in aortic stenosis: a review of current and future strategies

Russell James Everett et al. Heart. 2018 Dec.
No abstract available

Keywords: aortic stenosis; cardiac magnetic resonance (cmr) imaging; transcatheter valve interventions; valve disease surgery.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
ESC/EACTS algorithm for management of severe AS (2017 guidelines). AS, aortic stenosis; LVEF, left ventricular ejection fraction; SAVR, surgical aortic valve replacement; TAVI, transcatheter aortic valve implantation.
Figure 2
Figure 2
Optimising the timing of aortic valve intervention in progressive aortic stenosis. TAVI, transcatheter aortic valve insertion.
Figure 3
Figure 3
Comparison of EARLY-TAVR and EVoLVeD randomised controlled trial designs. Currently, recruiting randomised controlled trials generally fall into two groups: those investigating valve intervention in all asymptomatic patients with severe AS (eg, EARLY-TAVR) and those looking to target intervention based on measures of left ventricular decompensation (eg, EVoLVeD). AS, aortic stenosis; CMR, cardiac magnetic resonance; EARLY-TAVR, Evaluation of Transcatheter Aortic Valve Replacement Compared to SurveilLance for Patients with AsYmptomatic Severe Aortic Stenosis; EVoLVeD, Early Valve Replacement Guided by Biomarkers of Left Ventricular Decompensation in Asymptomatic Patients with Severe AS; hs, high-sensitivity; LV, left ventricular; TAVI, transcatheter aortic valve insertion.
Figure 4
Figure 4
Imaging and biomarker assessments of stage of valvular stenosis and myocardial response to increased afterload. Progressive haemodynamic obstruction as a result of aortic leaflet restriction is assessed using echocardiography. However, specific valvular pathologies such as fibrosis and calcification can be assessed using CT methods. Ejection fraction is a poorly sensitive marker of myocardial decompensation with abnormalities in Doppler measures, longitudinal strain and systolic function, which are all detectable prior to this. However, these measures, along with biomarkers such as troponin and B-type natriuretic peptide (BNP) are non-specific and may be abnormal as a result of coexistent myocardial pathology such as coronary heart disease. T1 mapping methods and late gadolinium enhancement are more specific for decompensation as a result of pressure overload.
See this image and copyright information in PMC

References

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