Natural History, Diagnostic Approaches, and Therapeutic Strategies for Patients With Asymptomatic Severe Aortic Stenosis

J Am Coll Cardiol. 2016 May 17;67(19):2263-2288. doi: 10.1016/j.jacc.2016.02.057. Epub 2016 Apr 2.

Abstract

Aortic stenosis (AS) is one of the most common valvular diseases encountered in clinical practice. Current guidelines recommend aortic valve replacement (AVR) when the aortic valve is severely stenotic and the patient is symptomatic; however, a substantial proportion of patients with severe AS are asymptomatic at the time of first diagnosis. Although specific morphological valve features, exercise testing, stress imaging, and biomarkers can help to identify patients with asymptomatic severe AS who may benefit from early AVR, the optimal management of these patients remains uncertain and controversial. The current report presents a comprehensive review of the natural history and the diagnostic evaluation of asymptomatic patients with severe AS, and is followed by a meta-analysis from reported studies comparing an early AVR strategy to active surveillance, with an emphasis on the level of evidence substantiating the current guideline recommendations. Finally, perspectives on directions for future investigation are discussed.

Keywords: aortic valve; aortic valve replacement; asymptomatic; prognosis.

Publication types

  • Review

MeSH terms

  • Aortic Valve / diagnostic imaging
  • Aortic Valve Stenosis / diagnosis*
  • Aortic Valve Stenosis / therapy*
  • Asymptomatic Diseases*
  • Biomarkers
  • Conservative Treatment
  • Death, Sudden / etiology
  • Diagnostic Imaging
  • Disease Progression
  • Echocardiography, Stress
  • Exercise Test
  • Heart Valve Prosthesis
  • Humans
  • Natriuretic Peptide, Brain / blood
  • Peptide Fragments / blood
  • Practice Guidelines as Topic
  • Severity of Illness Index*
  • Stroke Volume

Substances

  • Biomarkers
  • Peptide Fragments
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain