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

Philippe Généreux*, Gregg W. Stone, Patrick T. O'Gara, Guillaume Marquis-Gravel, Björn Redfors, Gennaro Giustino, Philippe Pibarot, Jeroen J. Bax, Robert O. Bonow, Martin B. Leon

*Corresponding author for this work

Research output: Contribution to journalReview article

92 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2263-2288
Number of pages26
JournalJournal of the American College of Cardiology
Volume67
Issue number19
DOIs
StatePublished - May 17 2016

Keywords

  • aortic valve
  • aortic valve replacement
  • asymptomatic
  • prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Généreux, P., Stone, G. W., O'Gara, P. T., Marquis-Gravel, G., Redfors, B., Giustino, G., Pibarot, P., Bax, J. J., Bonow, R. O., & Leon, M. B. (2016). Natural History, Diagnostic Approaches, and Therapeutic Strategies for Patients with Asymptomatic Severe Aortic Stenosis. Journal of the American College of Cardiology, 67(19), 2263-2288. https://doi.org/10.1016/j.jacc.2016.02.057