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Current Management of Calcific Aortic Stenosis
Open accessAbstract
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 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]
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“there is no pharmacotherapy specifically targeting AS to prevent progressive leaflet calcification or to delay time to valve replacement3;199.”
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“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]
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“In many ways, this LV response considerably influences the morbidity and mortality of the disease199;257–260.”
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“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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Metadata
- Authors
- Lindman, B. R., Bonow, R. O., & Otto, C. M.
- Affiliations
- Northwestern University (US)
- Venue
- Circulation Research
- Published
- 2013-07-05
- Volume
- 113
- Issue
- 2
- Pages
- 223-237
- ISSN
- 0009-7330 (ISSN-L)
- 1524-4571
- 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 › Cardiology and Cardiovascular 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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