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- Title
Moderate aortic stenosis: Navigating the uncharted.
- Authors
Caprio, Maria Vittoria; De Donno, Federica; Bisaccia, Giandomenico; Mantini, Cesare; Di Baldassarre, Angela; Gallina, Sabina; Khanji, Mohammed Y.; Ricci, Fabrizio
- Abstract
Aortic stenosis (AS) stands as the most common valvular heart disease in developed countries and is characterized by progressive narrowing of the aortic valve orifice resulting in elevated transvalvular flow resistance, left ventricular hypertrophy, and progressive increased risk of heart failure and sudden death. This narrative review explores clinical challenges and evolving perspectives in moderate AS, where discrepancies between aortic valve area and pressure gradient measurements may pose diagnostic and therapeutic quandaries. Transthoracic echocardiography is the first‐line imaging modality for AS evaluation, yet cases of discordance may require the application of ancillary noninvasive diagnostic modalities. This review underscores the importance of accurate grading of AS severity, especially in low‐gradient phenotypes, emphasizing the need for vigilant follow‐up. Current clinical guidelines primarily recommend aortic valve replacement for severe AS, potentially overlooking latent risks in moderate disease stages. The noninvasive multimodality imaging approach—including echocardiography, cardiac magnetic resonance, computed tomography, and nuclear techniques—provides unique insights into adaptive and maladaptive cardiac remodeling in AS and offers a promising avenue to deliver precise indications and exact timing for intervention in moderate AS phenotypes and asymptomatic patients, potentially improving long‐term outcomes. Nevertheless, what we may have gleaned from a large amount of observational data is still insufficient to build a robust framework for clinical decision‐making in moderate AS. Future research will prioritize randomized clinical trials designed to weigh the benefits and risks of preemptive aortic valve replacement in the management of moderate AS, as directed by specific imaging and nonimaging biomarkers.
- Subjects
AORTIC stenosis treatment; MEDICAL protocols; AORTIC valve; COMPUTED tomography; SEVERITY of illness index; MAGNETIC resonance imaging; POSITRON emission tomography computed tomography; POSITRON emission tomography; DECISION making in clinical medicine; AORTIC stenosis; ECHOCARDIOGRAPHY; PATIENT aftercare; PHENOTYPES; EVALUATION
- Publication
Echocardiography, 2024, Vol 41, Issue 6, p1
- ISSN
0742-2822
- Publication type
Article
- DOI
10.1111/echo.15859