Diagnosing aortic stenosis patients

Aortic-stenosis-clinican-assessment

Severe aortic stenosis prevalence and prognosis

Estimated number of sAS patients in the European Union by age2

sAS patients in Europe

Adapted from Thoenes M et al. 2018

Defining and assessing aortic stenosis severity

2017 ESC/EACTS stepwise integrated approach for the assessment of aortic stenosis severity4

ESC-EACTS-stepwise-infographic

High gradient aortic stenosis

In patients present with high gradient AS, echocardiography alone is sufficient in determining severity of AS. Patients will require aortic valve replacement (AVR) if presenting with symptoms and/or left ventricular (LV) systolic dysfunction 6

Low gradient aortic stenosis

Asymptomatic severe aortic stenosis patients

Exercise testing is recommended for unmasking symptoms in patients who appear asymptomatic4

Exercise-testing-for-sAS-infographic

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References

  • 1 Edwards data on file.
  • 2 Thoenes M, et al. J Thorac Dis 2018; 10:5584-5594.
  • 3 Carabello BA. Circ Res 2013;113:179-185.
  • 4 Baumgartner H, et al. Eur Heart J 2017; 38:2739-2791.
  • 5 Otto CM. Heart 2000; 84:211-218.
  • 6 Delgado V, et al. J Am Coll Cardiol Img 2019;12:267–282.
  • 7 Amato MCM, et al. Heart 2001;86:381-386.
  • 8 Généreux P, et al. J Am Coll Cardiol 2016;67:2263–2268.

Echocardiography

Echocardiography can:
  • Confirm stenosis
  • Indicate the degree of valve calcification, left ventricular function and wall thickness
  • Detect the presence of other associated valve diseases and aortic pathologies
Factors to consider during echocardiography are:
  • Valve area
  • Flow rate
  • Mean pressure gradient
  • Ventricular function
  • Ventricular size and wall thickness
  • Degree of valve calcification
  • Blood pressure and functional status
Hypertensive patients should be reassessed when normotensive4

Why excercise test?

  • It is important to identify sAS patients with masked symptoms, as sudden death is reported in up to 6% of patients with asymptomatic sAS7
  • Exercise-testing apparently asymptomatic sAS patients can unmask symptoms so they can get the timely treatment required 4, 8
  • A pooled analysis showed 49% (212/434) of apparently asymptomatic sAS patients exhibited symptoms during stress testing8

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