We searched PubMed with the keyword “aortic stenosis”. We identified citations that formed a mix of important older studies and those published since 2000. Citations from journals with high impact factors were given special weight, and we attempted to balance sources from the USA and Europe.
ReviewAortic stenosis
Section snippets
Epidemiology
Aortic valvular abnormalities are quite frequent in old patients. In the Cardiovascular Health Study, in which 5201 men and women older than 65 years were examined, 26% of study participants had aortic sclerosis (a thickening of the valve or calcification without significant obstruction). A slight predominance of the disorder was noted in men. 2% of all patients had frank aortic stenosis.1 A clear increase in prevalence of sclerosis was seen with age: 20% in patients aged 65–75 years, 35% in
Calcific aortic stenosis
Once judged a degenerative disease, the mechanism by which a previously healthy tricuspid aortic valve becomes stenotic is now believed to be very similar to that of atherosclerosis. The initial plaque of aortic stenosis is alike that of coronary artery disease.2 Risk factors associated with coronary artery disease—including age, male sex, hyperlipidaemia, and evidence of active inflammation—are held in common by the two disorders.3 Further, there is a high coincidence of both diseases in the
Pathophysiology and relation to symptoms
Onset of severe symptoms of aortic stenosis—angina, syncope, and heart failure—remains the major demarcation point in the disease's course (figure 1).19 The asymptomatic patient has a good outlook even with severe obstruction, whereas an individual with symptoms has a mortality rate of about 25% per year. Thus, knowing how the pathophysiology of aortic stenosis causes symptoms and death is paramount to understanding the disease.
Physical examination
Aortic stenosis is usually detected initially by auscultation that indicates the typical crescendo-decrescendo systolic ejection murmur radiating to the neck. In mild disease, the murmur peaks early in systole, S2 is physiologically split, and carotid upstrokes are normal. This condition—in which a thickened valve causes no appreciable obstruction to outflow—is termed aortic sclerosis. Although by itself benign, presence of aortic sclerosis is associated with a substantial increase in risk for
Medical treatment
Severe symptomatic aortic stenosis is a lethal obstruction to outflow that needs effective mechanical relief in the form of valve replacement for most patients. No medical treatment is effective for chronic disease. However, as noted above (see section on Causes), modern ideas about valve pathology (rather than the effects of stenosis on the heart and body) indicate that aortic stenosis is caused by an active inflammatory process akin to that of atherosclerosis.60, 61 Thus unsurprisingly,
Conclusions and future work
Symptomatic severe aortic stenosis is a fatal disease when treated medically, but after aortic valve replacement a patient's lifespan returns to near that of an unselected population.94 Even individuals with advanced disease and left-ventricular dysfunction can have a good outcome, especially when the reason for the dysfunction is a large transvalvular gradient causing high afterload. In people with aortic stenosis and a low gradient and low ejection fraction, prognosis is worse but is still
Search strategy and selection criteria
References (94)
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The epidemiology of valvular heart disease: a growing public health problem
Heart Fail Clin
(2006) - et al.
Association of coronary risk factors and use of statins with progression of mild valvular aortic stenosis in older persons
Am J Cardiol
(2001) - et al.
Relation of aortic valve sclerosis to risk of coronary heart disease in African-Americans
Am J Cardiol
(2005) - et al.
Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis
J Am Coll Cardiol
(2007) - et al.
Orifice variability of the stenotic aortic valve: evaluation before and after balloon aortic valvuloplasty
J Am Coll Cardiol
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Left ventricular wall stress in compensated aortic stenosis in children
Am J Cardiol
(1983) Anatomically isolated aortic valvular disease: the case against its being of rheumatic etiology
Am J Med
(1970)- et al.
Syncope and sudden death in aortic stenosis
Am J Cardiol
(1969) - et al.
Syncope in aortic valvular stenosis
Lancet
(1984) - et al.
Usefulness of an elevated B-type natriuretic peptide in predicting survival in patients with aortic stenosis treated without surgery
Am J Cardiol
(2005)
Relationship between renal function and plasma brain natriuretic peptide in patients with heart failure
J Am Coll Cardiol
Plasma concentrations of atrial, brain, and C-type natriuretic peptides and endothelin-1 in patients with chronic respiratory diseases
Chest
B-type natriuretic peptide levels in obese patients with advanced heart failure
J Am Coll Cardiol
Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts
Am Heart J
Is peripheral arterial pressure a satisfactory substitute for ascending aortic pressure when measuring aortic valve gradients?
J Am Coll Cardiol
New concepts in valvular hemodynamics: Implications for diagnosis and treatment of aortic stenosis
Can J Cardiol
Comparison of outcome of asymptomatic to symptomatic patients older than 20 years of age with valvular aortic stenosis
Am J Cardiol
The natural history of adults with asymptomatic, hemodynamically significant aortic stenosis
J Am Coll Cardiol
Metabolic syndrome negatively influences disease progression and prognosis in aortic stenosis
J Am Coll Cardiol
Prognosis after valve replacement in patients with severe aortic stenosis and a low transvalvular pressure gradient
J Am Coll Cardiol
Aortic valve replacement in patients with mild or moderate aortic stenosis and coronary bypass surgery
Am J Med
Should coronary artery bypass graft surgery patients with mild or moderate aortic stenosis undergo concomitant aortic valve replacement? A decision analysis approach to the surgical dilemma
J Am Coll Cardiol
Aortic valve replacement in patients aged eighty years and older: early and long-term results
J Thorac Cardiovasc Surg
Catheter balloon valvuloplasty for severe calcific aortic stenosis: a limited role
J Am Coll Cardiol
Treatment of calcific aortic stenosis with the percutaneous heart valve: mid-term follow-up from the initial feasibility studies—the French experience
J Am Coll Cardiol
Characterization of the early lesion of ‘degenerative’ valvular aortic stenosis: histological and immunohistochemical studies
Circulation
Association of aortic-valve sclerosis with cardiovascular mortality and morbidity in the elderly
N Engl J Med
Targeted therapy to prevent progression of calcific aortic stenosis
Circulation
Effect of hydroxymethylglutaryl coenzyme a reductase inhibitors on the progression of calcific aortic stenosis
Circulation
A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis
N Engl J Med
Low-output, low-gradient aortic stenosis in patients with depressed left ventricular systolic function: the clinical utility of the dobutamine challenge in the catheterization laboratory
Circulation
Low-flow, low-gradient aortic stenosis: from evaluation to treatment
Curr Opin Cardiol
Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation
Circulation
Left ventricular outflow obstruction: subaortic stenosis, bicuspid aortic valve, supravalvar aortic stenosis, and coarctation of the aorta
Circulation
Aortic root geometry: pattern of differences between leaflets and sinuses of valsalva
J Heart Valve Dis
Second natural history study of congenital heart defects: results of treatment of patients with aortic valvular stenosis
Circulation
Aortic stenosis
Circulation
Wall stress and patterns of hypertrophy in the human left ventricle
J Clin Invest
Premorbid determinants of left ventricular dysfunction in a novel model of gradually induced pressure overload in the adult canine
Circulation
RGS4 causes increased mortality and reduced cardiac hypertrophy in response to overload
J Clin Invest
Cardiac hypertrophy is not a required compensatory response to short-term pressure overload
Circulation
Prognostic implications of echocardiographically determined left ventricular mass in the Framingham heart study
N Engl J Med
Tolerance of the hypertrophic heart to ischemia: studies in compensated and failing dog hearts with pressure overload hypertrophy
Circulation
Decreased coronary reserve: a mechanism for angina pectoris in patients with aortic stenosis and normal coronary arteries
N Engl J Med
Myocardial characteristics of pressure overload hypertrophy: a structural and functional study
Lab Invest
Functional changes in coronary microcirculation after valve replacement in patients with aortic stenosis
Circulation
Why angina in aortic stenosis with normal coronary arteriograms?
Circulation
Cited by (649)
MV-MS-FETE: Multi-view multi-scale feature extractor and transformer encoder for stenosis recognition in echocardiograms
2024, Computer Methods and Programs in BiomedicineHigh-risk admission prior to transcatheter aortic valve replacement and subsequent outcomes
2024, American Heart JournalLeft ventricular reverse remodeling after transcatheter aortic valve implantation in patients with low-flow low-gradient aortic stenosis
2023, Hellenic Journal of CardiologyAn FSEI approach for the assessment of stenotic aortic valve effects on the left heart hemodynamics
2023, Computers and FluidsTrends in Economic Burden and Mortality of Hospitalized Patients With Aortic Stenosis in Thailand
2023, American Journal of Cardiology