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Management of asymptomatic severe aortic stenosis.

Stewart RL, Chan KL - Curr Cardiol Rev (2009)

Bottom Line: Patients with symptomatic severe aortic stenosis (AS) benefit from aortic valve replacement surgery, but the management of patients with asymptomatic severe AS is more controversial.Clinical factors, echocardiographic parameters, valve morphology, exercise stress testing results, and cardiac biomarkers may be useful in identifying patients who will have early development of symptoms during follow-up and require closer monitoring.The risks associated with aortic valve replacement outweigh the benefits in the majority of patients with asymptomatic severe AS.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

ABSTRACT
Patients with symptomatic severe aortic stenosis (AS) benefit from aortic valve replacement surgery, but the management of patients with asymptomatic severe AS is more controversial. While cholesterol and angiotensin have been linked to AS progression, we should await the results of ongoing randomized trials before medical therapy to lower cholesterol or inhibit angiotensin can be recommended to limit disease progression. Clinical factors, echocardiographic parameters, valve morphology, exercise stress testing results, and cardiac biomarkers may be useful in identifying patients who will have early development of symptoms during follow-up and require closer monitoring. The risks associated with aortic valve replacement outweigh the benefits in the majority of patients with asymptomatic severe AS.

No MeSH data available.


Related in: MedlinePlus

Progression of AS in patients treated with intensive atorvastatin therapy on matched placebo. [from reference 22 with permission].
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Figure 1: Progression of AS in patients treated with intensive atorvastatin therapy on matched placebo. [from reference 22 with permission].

Mentions: Currently, the only published randomized controlled trial looking at statin therapy in AS is the SALTIRE study (Scottish Aortic Stenosis and Lipid Lowering Trial, Impact on Regression) [32]. One hundred and fifty-five patients were randomized to atorvastatin 80 mg daily or placebo to test the hypothesis that intensive lipid-lowering therapy would halt the progression of AS as assessed by aortic jet velocity on Doppler echocardiography and aortic valve calcium score on computed tomography. Patients with a peak AS velocity of ≥2.5 m/s and aortic valve calcification on echocardiography were enrolled. The average peak AS velocity was 3.43 m/s, the average AVA was 1.03 cm2, and aortic valve calcium score was 5920 log arbitrary units. Thirty-six patients had severe AS based on a peak AS velocity ≥4.0 m/s. Patients were followed for a median of 25 months. Despite a significant change in the mean LDL cholesterol on treatment between the two groups (53% decrease in atorvastatin grouped versus no change in placebo group, P<0.001), there was no difference in measures of AS progression between the two groups (increase in peak aortic jet velocity of 0.20 m/s in both groups, P=0.95; increase in valvular calcification 22.3% per year in the atorvastatin group versus 21.7% per year in the placebo group, P=0.93) Fig. (1).


Management of asymptomatic severe aortic stenosis.

Stewart RL, Chan KL - Curr Cardiol Rev (2009)

Progression of AS in patients treated with intensive atorvastatin therapy on matched placebo. [from reference 22 with permission].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2803285&req=5

Figure 1: Progression of AS in patients treated with intensive atorvastatin therapy on matched placebo. [from reference 22 with permission].
Mentions: Currently, the only published randomized controlled trial looking at statin therapy in AS is the SALTIRE study (Scottish Aortic Stenosis and Lipid Lowering Trial, Impact on Regression) [32]. One hundred and fifty-five patients were randomized to atorvastatin 80 mg daily or placebo to test the hypothesis that intensive lipid-lowering therapy would halt the progression of AS as assessed by aortic jet velocity on Doppler echocardiography and aortic valve calcium score on computed tomography. Patients with a peak AS velocity of ≥2.5 m/s and aortic valve calcification on echocardiography were enrolled. The average peak AS velocity was 3.43 m/s, the average AVA was 1.03 cm2, and aortic valve calcium score was 5920 log arbitrary units. Thirty-six patients had severe AS based on a peak AS velocity ≥4.0 m/s. Patients were followed for a median of 25 months. Despite a significant change in the mean LDL cholesterol on treatment between the two groups (53% decrease in atorvastatin grouped versus no change in placebo group, P<0.001), there was no difference in measures of AS progression between the two groups (increase in peak aortic jet velocity of 0.20 m/s in both groups, P=0.95; increase in valvular calcification 22.3% per year in the atorvastatin group versus 21.7% per year in the placebo group, P=0.93) Fig. (1).

Bottom Line: Patients with symptomatic severe aortic stenosis (AS) benefit from aortic valve replacement surgery, but the management of patients with asymptomatic severe AS is more controversial.Clinical factors, echocardiographic parameters, valve morphology, exercise stress testing results, and cardiac biomarkers may be useful in identifying patients who will have early development of symptoms during follow-up and require closer monitoring.The risks associated with aortic valve replacement outweigh the benefits in the majority of patients with asymptomatic severe AS.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.

ABSTRACT
Patients with symptomatic severe aortic stenosis (AS) benefit from aortic valve replacement surgery, but the management of patients with asymptomatic severe AS is more controversial. While cholesterol and angiotensin have been linked to AS progression, we should await the results of ongoing randomized trials before medical therapy to lower cholesterol or inhibit angiotensin can be recommended to limit disease progression. Clinical factors, echocardiographic parameters, valve morphology, exercise stress testing results, and cardiac biomarkers may be useful in identifying patients who will have early development of symptoms during follow-up and require closer monitoring. The risks associated with aortic valve replacement outweigh the benefits in the majority of patients with asymptomatic severe AS.

No MeSH data available.


Related in: MedlinePlus