What is the management of patients with aortic stenosis (symptomatic and asymptomatic)?
Aortic stenosis (AS) patients who are asymptomatic should be followed clinically and by echocardiogram. The ACC/AHA guidelines [1] recommend asymptomatic AS patients to have serial echocardiographic testing with the following time intervals:
- Severe AS: every year
- Moderate AS: every two years
- Mild AS: every five years
Echocardiograms should be performed whenever there is an important change in clinical symptoms or findings.
Indications for aortic valve replacement for aortic stenosis include:
- Angina
- Congestive Heart Failure (CHF)
- Syncope or presyncope
- Episode of aborted sudden death
If a stenotic valve is not replaced, approximately 50% of patients will be dead:
- Within 5 yrs after angina develops
- Within 3 yrs after exertional syncope develops
- Within 2 yrs after heart failure develops
Symptoms are usually associated with:
- aortic valve area (AVA) >0.8 cm2
- and/or transvalvular mean gradient >50 mmHg.
Patients often exhibited symptomatic improvement and increased in survival after AVR.
Reference:
Nishimur RA, et al. ACC/AHA 2014 practice guidelines for the management of patients with valvular heart disease: executive summary. JACC 2014 Jun 10;63(22):2438-88
