Patient screening for early detection of aortic stenosis (AS)-review of current practice and future perspectives

Abstract

In Europe, approximately one million people over 75 years suffer from severe aortic stenosis (AS), one of the most serious and most common valve diseases, and this disease burden is increasing with the aging population. A diagnosis of severe symptomatic AS is associated with an average life expectancy of 2-3 years and necessitates a timely valve intervention. Guidelines for valve replacement therapy have been established but only a proportion of patients with symptomatic AS actually receive this life-saving treatment. The decision for valve intervention in asymptomatic patients with severe AS is often more challenging and likely results in fewer patients receiving treatment in comparison to their symptomatic counterparts. This article reviews the epidemiology and clinical manifestations of AS, the associated economic burden of AS to the healthcare system, the diagnosis of AS and the possible mechanisms for the introduction of routine screening in elderly patients. Elderly patients typically visit healthcare providers more frequently than younger patients, thereby providing increased opportunities for ad hoc AS screening and this, along with raising patient awareness of the symptoms of AS, has the potential to result in the earlier diagnosis and treatment of AS and increased patient survival.

Keywords: Aortic stenosis (AS); auscultation, screening; transthoracic echocardiography (TTE); valvular heart disease.

Figure 1

Estimated number of patients in Europe with severe, moderate and mild AS (Edwards Lifesciences, data/references on file). AS, aortic stenosis.

Figure 2

Estimated number of patients being diagnosed with severe symptomatic aortic stenosis in the European Union by age and the proportion of patients remaining undiagnosed or undergoing SAVR or TAVI (Edwards Lifesciences, data/references on file). SAVR, surgical aortic valve replacement; TAVI, transcatheter aortic valve implantation; AS, aortic stenosis.

Figure 3

Echocardiology images for aortic valve sclerosis (left panel) and severe aortic stenosis (right panel).

Figure 4

All-in-one handheld echocardiogram devices with electronic transducers [Chamsi-Pasha et al. (70). (A,B) Vscan with dual probe (A) and Vscan Extend (B) (image courtesy of GE Healthcare, Wauwatosa, WI); (C) Acuson P10, © Siemens Healthineers 2017 (used with permission), Siemens Medical Solutions Inc., Malvern, PA; (D) Iviz; (E) 180 Plus; (F) iLook; (G) Nano-Maxx (D,E,F,G images courtesy of FUJIFILM SonoSite Inc., Bothell, WA); (H) uSmart 3200T (image courtesy of Terason Division, Teratech Corporation, Burlington, MA); (I) Sonimage P3 (used with permission), Konica Minolta Healthcare Americas, Inc., Wayne, NJ.