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Aortic Stenosis

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Heart Valve Disease

Abstract

Calcific aortic stenosis (AS) is a slowly progressive disease that is characterized by fibro-calcific remodeling and stiffening of valve leaflets, which cause progressive obstruction of LV outflow. AS is the second most frequent cardiovascular disease after coronary artery disease and hypertension with a prevalence of 0.4% in the general population and 1.7% in the population over 65 years old. Congenital abnormality (bicuspid valve) and older age are the most important risk factors for AS. The pathobiology of AS is complex and involves genetic factors, lipoprotein deposition and oxidation, chronic inflammation, osteoblastic transition of valvular interstitial cells, apoptosis, and active leaflet calcification. Until now, no pharmacotherapy has proven to be effective in reducing the progression of AS. Promising therapeutic targets include Lipoprotein (a), renin-angiotensin system, and Palmdelphin. For now, aortic valve replacement (AVR) remains the sole effective option for the treatment of severe AS. AVR is indicated in presence of: (i) severe AS and (ii) symptoms and/or LV systolic dysfunction. The grading of AS severity and staging of associated cardiac damage are primarily based on Doppler-echocardiography but other imaging modalities such as multi-detector computed tomography that may provide important complementary information, particularly in patients with low-gradient AS. The introduction of transcatheter AVR in the past decade has been a transformative innovation for patients at extreme, high, or intermediate surgical risk and this new technology may extend to low risk patients in the near future.

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Abbreviations

AS:

Aortic stenosis

AVA:

Aortic valve area

AVR:

Aortic valve replacement

CMR:

Cardiac magnetic resonance

DSE:

Dobutamine stress echocardiography

LVEF:

LV ejection fraction

MDCT:

Multi-detector computed tomography

SAVR:

Surgical aortic valve replacement

TAVI:

Transcatheter aortic valve implantation

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Disclosure

Dr. Pibarot has Core Lab contracts with Edwards Lifesciences, for which he receives no direct compensation; and is a speaker for St. Jude Medical. The other authors have no disclosure. Dr. Clavel has Core Lab contracts with Edwards Lifesciences, for which she receives no direct compensation; and research grant with Medtronic.

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Authors and Affiliations

  1. Québec Heart & Lung Institute, Department of Medicine, Laval University, Québec, QC, Canada

    Marie-Annick Clavel, Nancy Côté & Philippe Pibarot

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  1. Marie-Annick Clavel
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  2. Nancy Côté
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  3. Philippe Pibarot
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Correspondence to Philippe Pibarot .

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  1. Hospital Universitario Ramón y Cajal, Madrid, Spain

    Jose Zamorano

  2. Cardiology, University Hospital Sart Tilman Cardiology, Liège, Belgium

    Patrizio Lancellotti

  3. University of Liège, Liège, Belgium

    Luc Pierard

  4. Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec Heart & Lung Institute, QC, Canada

    Philippe Pibarot

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Clavel, MA., Côté, N., Pibarot, P. (2020). Aortic Stenosis. In: Zamorano, J., Lancellotti, P., Pierard, L., Pibarot, P. (eds) Heart Valve Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-23104-0_3

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  • DOI: https://doi.org/10.1007/978-3-030-23104-0_3

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