Aortic Valvular Stenosis and Heart Failure: Advances in Diagnostic, Management, and Intervention

Heart Fail Clin. 2023 Jul;19(3):273-283. doi: 10.1016/j.hfc.2023.02.005. Epub 2023 Apr 4.

Abstract

Up to 30% of patients with aortic stenosis (AS) present with heart failure (HF) symptoms with either reduced or preserved left ventricular ejection fraction. Many of these patients present with a low-flow state, reduced aortic-valve-area (≤1.0 cm2) with low aortic-mean-gradient and aortic-peak-velocity (<40 mm Hg and <4.0 m/s). Thus, determination of true severity is essential for correct management, and multi-imaging evaluation must be performed. Medical treatment of HF is imperative and should be optimized concurrently with the determination of AS-severity. Finally, AS should be treated according to guidelines, keeping in mind that HF and low-flow increase interventions risks.

Keywords: Aortic stenosis; Computed tomography; Echocardiography; Heart failure; Left ventricular ejection fraction.

Publication types

  • Review

MeSH terms

  • Aortic Valve / diagnostic imaging
  • Aortic Valve / surgery
  • Aortic Valve Stenosis* / complications
  • Aortic Valve Stenosis* / diagnosis
  • Aortic Valve Stenosis* / surgery
  • Constriction, Pathologic
  • Heart Failure* / diagnosis
  • Heart Failure* / therapy
  • Heart Valve Prosthesis Implantation*
  • Humans
  • Severity of Illness Index
  • Stroke Volume
  • Ventricular Function, Left