Current Management of Calcific Aortic Stenosis

Lindman, Brian R.; Bonow, Robert O.; Otto, Catherine M.

doi:10.1161/circresaha.111.300084

Cited by 175Cardiac Valve Diseases and TreatmentsAortic Disease and Treatment ApproachesCardiac Imaging and Diagnostics

Current Management of Calcific Aortic Stenosis

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Lindman, Brian R., Bonow, Robert O., Otto, Catherine M.·2013·Circulation Research

DOI 10.1161/circresaha.111.300084PMC PMC4013234

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Abstract

Calcific aortic stenosis is a progressive disease with no effective medical therapy that ultimately requires aortic valve replacement (AVR) for severe valve obstruction. Echocardiography is the primary diagnostic approach to define valve anatomy, measure aortic stenosis severity, and evaluate the left ventricular response to chronic pressure overload. In asymptomatic patients, markers of disease progression include the degree of leaflet calcification, hemodynamic severity of stenosis, adverse left ventricular remodeling, reduced left ventricular longitudinal strain, myocardial fibrosis, and pulmonary hypertension. The onset of symptoms portends a predictably high mortality rate unless AVR is performed. In symptomatic patients, AVR improves symptoms, improves survival, and, in patients with left ventricular dysfunction, improves systolic function. Poor outcomes after AVR are associated with low-flow low-gradient aortic stenosis, severe ventricular fibrosis, oxygen-dependent lung disease, frailty, advanced renal dysfunction, and a high comorbidity score. However, in most patients with severe symptoms, AVR is lifesaving. Bioprosthetic valves are recommended for patients aged >65 years. Transcatheter AVR is now available for patients with severe comorbidities, is recommended in patients who are deemed inoperable, and is a reasonable alternative to surgical AVR in high-risk patients.

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Severe aortic stenosis primarily impairs quality of life by causing heart failure symptoms including shortness of breath, fatigue and diminished functional capacity.
“Severe AS primarily impairs quality of life by causing heart failure symptoms including shortness of breath, fatigue and diminished functional capacity199;252.”
From Calcific aortic stenosis (2016) · cites this paper as [199]
The 'Symptom onset' section identifies exertional dyspnea as the most common early symptom and describes declining exercise tolerance and functional capacity in adults with severe AS. The 'Heart failure' section also discusses heart failure symptoms in severe AS. Our copy does not identify fatigue or establish that these symptoms are the primary way severe AS impairs quality of life. (LLM, conf=0.85)
Experimental — accuracy not yet measured
No pharmacotherapy specifically targets aortic stenosis to prevent progressive leaflet calcification or delay valve replacement.
“there is no pharmacotherapy specifically targeting AS to prevent progressive leaflet calcification or to delay time to valve replacement3;199.”
From Calcific aortic stenosis (2016) · cites this paper as [199]
Aortic valve replacement is indicated in patients with severe symptomatic aortic stenosis both to increase life expectancy and to improve symptoms and quality of life.
“AVR is indicated in patients with severe symptomatic AS both to increase life expectancy and improve symptoms and quality of life3;4;199;202;252;253.”
From Calcific aortic stenosis (2016) · cites this paper as [199]
Experimental — accuracy not yet measured
This LV response considerably influences the morbidity and mortality of aortic stenosis.
“In many ways, this LV response considerably influences the morbidity and mortality of the disease199;257–260.”
From Calcific aortic stenosis (2016) · cites this paper as [199]
The LV response to chronic pressure overload from aortic stenosis is characterized by hypertrophic remodelling with myocyte hypertrophy and fibrosis, and by diastolic and systolic dysfunction.
“The LV response to chronic pressure overload from AS is characterized by hypertrophic remodelling (myocyte hypertrophy and fibrosis) and diastolic and systolic dysfunction.”
From Calcific aortic stenosis (2016) · cites this paper as [199]

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Unoperated Patients With Severe Aortic Stenosis
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Comparison of Brain Natriuretic Peptide Plasma Levels Versus Logistic EuroSCORE in Predicting In-Hospital and Late Postoperative Mortality in Patients Undergoing Aortic Valve Replacement for Symptomatic Aortic Stenosis
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The Adverse Impact of Diabetes Mellitus on Left Ventricular Remodeling and Function in Patients With Severe Aortic Stenosis
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Aortic Valve Replacement Should Be Operated on Before Symptom Onset
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Midwall Fibrosis Is an Independent Predictor of Mortality in Patients With Aortic Stenosis
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Bicuspid Aortic Valve and Aortopathy: See the First, Then Look at the Second
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2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
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2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease
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2014 AHA/ACC guideline for the management of patients with valvular heart disease
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Calcific aortic stenosis
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Aortic-Valve Stenosis — From Patients at Risk to Severe Valve Obstruction
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Calcific Aortic Valve Disease
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Association Between Cardiovascular Risk Factors and Aortic Stenosis
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Knowledge Gaps in Cardiovascular Care of the Older Adult Population
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LncRNA MALAT1 sponges miR-204 to promote osteoblast differentiation of human aortic valve interstitial cells through up-regulating Smad4
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Potential drug targets for calcific aortic valve disease
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Freedom SOLO-Associated Thrombocytopaenia is Valve-Dependent and Not Due to In Vitro Pseudothrombocytopaenia
Stanger, O., Gahl, B., Grabherr, M., Krausler, R., Longnus, S., Meinitzer, A., & Cadamuro, J. (2016) · Heart Lung and Circulation · doi:10.1016/j.hlc.2016.07.002 · Cited by 7 · see citing works
Heterogeneity of systolic dysfunction in patients with severe aortic stenosis and preserved ejection fraction
Lindman, B. R., Liu, Q., Cupps, B. P., Woodard, P. K., Novak, E. L., Vatterott, A. M., Koerner, D. J., Kulshrestha, K., & Pasque, M. K. (2017) · Journal of Cardiac Surgery · doi:10.1111/jocs.13183 · Cited by 7 · see citing works
Self-citation
Calcific aortic stenosis: known facts and promising studies
Karpova, N. Y., Rashid, M. A., Казакова, Т. В., Chipigina, N. S., & Zudilina, A. E. (2020) · The Clinician · doi:10.17650/1818-8338-2020-14-1-2-34-41 · Cited by 9 · see citing works

Authors: Lindman, B. R., Bonow, R. O., & Otto, C. M.
Affiliations: Northwestern University (US)
ORCID: Lindman, Brian R.
Bonow, Robert O.
Otto, Catherine M.
Venue: Circulation Research
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2013-07-05
Volume: 113
Issue: 2
Pages: 223-237
ISSN: 0009-7330 (ISSN-L)
1524-4571
DOI: 10.1161/circresaha.111.300084
PMC: PMC4013234
OpenAlex: W2135349455
Cited by: 175
References: 118
Citations by year: 2026: 8 · 2025: 7 · 2024: 9 · 2023: 5 · 2022: 12 · 2021: 15 · 2020: 23 · 2019: 9 · 2018: 7 · 2017: 19 · 2016: 19 · 2015: 18 · 2014: 20 · 2013: 4
FWCI: 3.47
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Circulation Research (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (KL2TR000450, UL1TR000448)
National Heart, Lung, and Blood Institute (L30 HL104696, K23HL116660)
National Center for Advancing Translational Sciences
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Keywords: calcific aortic stenosis, aortic valve replacement, transcatheter aortic valve implantation, bioprosthetic heart valves, left ventricular remodeling, low-flow low-gradient aortic stenosis, myocardial fibrosis, pulmonary hypertension, frailty, comorbidities, disease progression biomarkers, left ventricular longitudinal strain
MeSH terms: Animals, Aortic Valve Stenosis, Calcinosis, Humans, Cardiomyopathies, Disease Management

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