Review Article
Volume 13, Issue 2 Part 1, February 2020
JOURNAL：JACC Cardiovasc Imaging.
Article Link
Management of Asymptomatic Severe Aortic Stenosis: Evolving Concepts in Timing of Valve Replacement
BR Lindman, MR Dweck, P Lancellotti et al.
KEYWORDS
aortic stenosis; biomarkers; cardiac magnetic resonance imaging; echocardiography
New insights into the pathophysiology and natural history of patients with aortic stenosis, coupled with advances in diagnostic imaging and the dramatic evolution of transcatheter aortic valve replacement, are fueling intense interest in the management of asymptomatic patients with severe aortic stenosis. An intervention that is less invasive than surgery could conceivably justify pre-emptive transcatheter aortic valve replacement in subsets of patients, rather than waiting for the emergence of early symptoms to trigger valve intervention. Clinical experience has shown that symptoms can be challenging to ascertain in many sedentary, deconditioned, and/or elderly patients. Evolving data based on imaging and biomarker evidence of adverse ventricular remodeling, hypertrophy, inflammation, or fibrosis may radically transform existing clinical decision paradigms. Clinical trials currently enrolling asymptomatic patients have the potential to change practice patterns and lower the threshold for intervention.
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