Moderate Aortic Stenosis and Reduced Left Ventricular Ejection Fraction: Current Evidence and Challenges Ahead

Frontiers in Cardiovascular Medicine
Ernest SpitzerNicolas M Van Mieghem

Abstract

Moderate aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF) constitute a clinical entity that has been proposed as a therapeutic target for transcatheter aortic valve replacement (TAVR). It is defined by a mean trans-aortic gradient between 20 and 40 mmHg and an aortic valve area between 1.0 and 1.5 cm2 in patients with LVEF < 50%. Retrospective data suggests a prevalence of 0.8% among patients referred for echocardiographic assessment. These patients are younger and show a higher frequency of previous myocardial infarction than those with severe AS randomized to TAVR in recent trials. In two retrospective studies including patients with moderate AS and reduced LVEF, a one-year mortality rate of 9 and 32% was reported, the latter in patients treated with medical therapy only during follow-up. Echocardiographic diagnosis of moderate AS poses challenges as current guidelines are directed to determine severe AS, and different presentations of moderate and mild AS have been generally neglected. Thus, the nomenclature would need to be revised and a description of possible scenarios is provided in this review. Dobutamine stress echocardiography and computed tomography are promising complementary tools. Likewis...Continue Reading

References

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Jun 6, 2018·Frontiers in Cardiovascular Medicine·Ole De Backer, Lars Søndergaard

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Citations

Jul 1, 2020·Expert Review of Medical Devices·Stephan Milhorini PioVictoria Delgado
Jul 11, 2020·Current Cardiology Reports·Vidhu AnandMackram Eleid
Jul 15, 2020·International Urology and Nephrology·Łukasz KuźmaSławomir Dobrzycki
Jan 10, 2021·European Journal of Heart Failure·Harminder GillBernard Prendergast

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Methods Mentioned

BETA
coronary artery bypass

Clinical Trials Mentioned

NCT02661451

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