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Severe and Asymptomatic Aortic Stenosis Management Challenge: Knowing That We Do Not Really Know

  • Lionel Tastet
  • Louis Simard
  • Marie-Annick Clavel
Valvular Heart Disease (J Dal-Bianco, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Valvular Heart Disease

Opinion statement

The clinical management of asymptomatic patients with severe aortic valve stenosis (AS) may be challenging. Indeed, there is substantial controversy over the optimal timing of intervention for these patients, as some advocate early intervention while others urge for a conservative management until symptom onset. In the meantime of randomized clinical trials aiming to compare both strategies of management, an integrative approach including several imaging modalities as well as biomarkers of the myocardial damage may help to improve the risk stratification of patients with asymptomatic severe AS and individualize strategy of treatment. The extent of aortic valve calcification, semi-quantitatively assessed by echocardiography but better fully quantitatively measured by computed tomography (CT), provides incremental value to predict rapid disease progression and adverse event and thus could be a potential trigger for early referral to intervention or guide the timing of clinical follow-up. In addition, the assessment of disease activity using positron emission tomography, combined with CT calcium scoring, may also help to better predict the disease progression. The comprehensive assessment of left ventricular (LV) function using speckle-tracking echocardiography and/or cardiac magnetic resonance may provide useful information regarding the actual repercussion of AS on the myocardium. Besides imaging modalities, the measurement of several circulating biomarkers associated with the extent of the myocardial damage may also improve the risk stratification of asymptomatic patients with severe AS and help guiding management. Finally, it should be emphasized that a personalized medicine, including this comprehensive integrative approach in heart valve clinics, should be advocated for the management of these challenging patients.

Keywords

Left ventricular (LV) function Magnetic resonance Echocardiography Valvular heart disease Aortic valve stenosis Asymptomatic patients Computed tomography 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Lionel Tastet
    • 1
  • Louis Simard
    • 1
  • Marie-Annick Clavel
    • 1
  1. 1.Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute)Université LavalQuébecCanada

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