AORTIC STENOSIS, DIAGNOSIS, TREATMENT TACTICS. WHAT IS IMPORTANT FOR THE THERAPIST TO KNOW?
https://doi.org/10.21886/2712-8156-2020-1-1-50-55
Abstract
Aortic stenosis is the most common manifestation of valve heart disease, which requires surgical or endovascular intervention. The prevalence of degenerative aortic stenosis is increasing due to an aging population. The clinical course of aortic stenosis is characterized by a long-existing asymptomatic period. The progressive calcification of the valve cusps leads to the formation of a pressure gradient in the aorta, hemodynamic overload of the left ventricle, the development of myocardial hypertrophy, which contributes to the violation of diastolic function of the left ventricle. After the onset of symptoms of aortic stenosis, the two-year survival in patients who do not undergo surgical correction does not exceed 50 %. The Recommendations of the European Association of Cardiology and the European Association of Cardiothoracic Surgeons for the treatment of patients with valvular heart disease in 2017 discuss aspects of the diagnosis of aortic stenosis and the principles of choosing tactics for managing patients using surgical or catheter treatment methods. Depending on the severity of aortic stenosis, its clinical manifestations, age of patients, and associated pathology, surgical replacement of the aortic valve or its transcatheter implantation may be recommended. The use of drug therapy for aortic stenosis did not show the possibility of improving the prognosis. Drug therapy is used to treat heart failure, hypertension. Important tasks are the control of sinus rhythm and the prevention of thromboembolic complications.
About the Authors
O. N. Kryuchkova
V.I. Vernadsky Crimean Federal University
Russian Federation
Russian Federation
Dr. Sci. (Med.), Prof.
Simferopol
E. A. Itskova
V.I. Vernadsky Crimean Federal University
Russian Federation
Cand. Sci. (Med.), Associate Prof.,
Simferopol
Russian Federation
Cand. Sci. (Med.), Associate Prof.,
Simferopol
Yu. A. Lutai
V.I. Vernadsky Crimean Federal University
Russian Federation
Russian Federation
Cand. Sci. (Med.), Associate Prof
Simferopol
E. U. Turna
V.I. Vernadsky Crimean Federal University
Russian Federation
Cand. Sci. (Med.),
Simferopol
Russian Federation
Cand. Sci. (Med.),
Simferopol
N. V. Zhukova
V.I. Vernadsky Crimean Federal University
Russian Federation
Cand. Sci. (Med.), Associate Prof.,
Simferopol
Russian Federation
Cand. Sci. (Med.), Associate Prof.,
Simferopol
E. A. Kostyukova
V.I. Vernadsky Crimean Federal University
Russian Federation
Russian Federation
Cand. Sci. (Med.), Associate Prof.,
Simferopol
References
1. Baumgartner H, Falk V, Bax JJ, Bonis MD, Hamm C, Holm PJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur.Heart J. 2017;36(21):2739-2791. https://doi.org/10.1093/eurheartj/ehx391
2. Iung B., Vahanian A. Epidemiology of valvular heart disease in the adult. Nat Rev Cardiol. 2011;8:162–172. https://doi.org/10.1038/nrcardio.2010.202.
3. Eveborn GW, Schirmer H, Heggelund G, Lunde P, Rasmussen K. The evolving epidemiology of valvular aortic stenosis. the Tromsø study. Heart. 2013;99(6):396–400. https://doi.org/10.1136/heartjnl-2012-302265.
4. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. The Lancet. 2006;368(9540):1005–1011. https://doi.org/10.1016/S0140-6736(06)69208-8
5. Azevedo CF, Nigri M, Higuchi ML, Pomerantzeff PM, Spina GS, Sampaio RO, et al. Prognostic significance of myocardial fibrosis quantification by histopathology and magnetic resonance imaging in patients with severe aortic valve disease. J Am Coll Cardiol. 2010;56(4):278–287. https://doi.org/10.1016/j.jacc.2009.12.074
6. Marechaux S, Hachicha Z, Bellouin A, Dumesnil JG, Meimoun P, Pasquet A, et al. Usefulness of exercise-stress echocardiography for risk stratification of true asymptomatic patients with aortic valve stenosis. Eur Heart J. 2010;31(11):1390–1397. https://doi.org/10.1093/eurheartj/ehq076
7. Clavel MA, Dumesnil JG, Capoulade R, Mathieu P, Senechal M, Pibarot P. Outcome of patients with aortic stenosis, small valve area, and low-flow, low-gradient despite preserved left ventricular ejection fraction. J Am Coll Cardiol. 2012;60:1259–1267. https://doi.org/10.1016/j.jacc.2011.12.054
8. Tribouilloy C, Rusinaru D, Marechaux S, Castel AL, Debry N, Maizel J, et al. Low-gradient, low-flow severe aortic stenosis with preserved left ventricular ejection fraction: characteristics, outcome, and implications for surgery. J Am Coll Cardiol. 2015;65:55–66. https://doi.org/10.1016/j.jacc.2014.09.080.
9. Rafique AM, Biner S, Ray I, Forrester JS, Tolstrup K, Siegel RJ. Meta-analysis of prognostic value of stress testing in patients with asymptomatic severe aortic stenosis. Am J Cardiol. 2009;104(7):972–977. https://doi.org/10.1016/j.amjcard.2009.05.044
10. Thourani VH, Suri RM, Gunter RL, Sheng S, O’Brien SM, Ailawadi G, et al. Contemporary real-world outcomes of surgical aortic valve replacement in 141,905 low-risk, intermediaterisk, and high-risk patients. Ann Thorac Surg. 2015;99(1):55–61. https://doi.org/10.1016/j.athoracsur.2014.06.050
11. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG. PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597–1607. https://doi.org/10.1056/NEJMoa1008232.
12. Thyregod HG, Steinbruchel DA, Ihlemann N, Nissen H, Kjeldsen BJ, Petursson P. Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis: 1-year results from the all-comers NOTION randomized clinical trial. J Am Coll Cardiol. 2015;65:2184–2194. https://doi.org/10.1016/j.jacc.2015.03.014.
13. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, et al. PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374:1609–1620. https://doi.org/10.1056/NEJMoa1514616.
14. Siontis GC, Praz F, Pilgrim T, Mavridis D, Verma S, Salanti G, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis: a meta-analysis of randomized trials. Eur Heart J. 2016;37:3503–3512. https://doi.org/10.1093/eurheartj/ehw225.
15. Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Sondergaard L, Mumtaz M, et al. SURTAVI Investigators. Surgical or transcatheter aortic-valve replacement in intermediaterisk patients. N Engl J Med. 2017;376:1321–1331. https://doi.org/10.1056/NEJMoa1700456.
16. Monin JL, Quere JP, Monchi M, Petit H, Baleynaud S, Chauvel C, et al. Low-gradient aortic stenosis: operative risk stratification and predictors for long-term outcome: a multicenter study using dobutamine stress hemodynamics. Circulation. 2003;108(3):319–324. https://doi.org/10.1161/01.CIR.0000079171.43055.46
17. Clavel MA Pibarot P, Messika-Zeitoun D, Capoulade R, Malouf J, Aggarval S, et al. Impact of aortic valve calcification, as measured by MDCT, on survival in patients with aortic stenosis: results of an international registry study. J Am Coll Cardiol. 2014;64(12):1202–1213. https://doi.org/10.1016/j.jacc.2014.05.066
18. Deeb GM, Reardon MJ, Chetcuti S, Patel HJ, Grossman PM. Clinical Investigators. 3-year outcomes in high-risk patients who underwent surgical or transcatheter aortic valve replacement. J Am Coll Cardiol. 2016;67:2565–2574. https://doi.org/10.1016/j.jacc.2016.03.506.
19. Adams DH, Popma JJ, Reardon MJ, Yakubov SJ. U.S. CoreValve Clinical Investigators. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014;370:1790–1798. https://doi.org/10.1056/NEJMoa1400590.
20. Thourani VH, Kodali S, Makkar RR, Herrmann HC, Williams M. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet. 2016;387:2218–2225. https://doi.org/10.1016/S0140-6736(16)30073-3.
21. Rogers T, Koifman E, Patel N, Gai J, Torguson R, Corso P, et al. Society of Thoracic Surgeons score variance results in risk reclassification of patients undergoing transcatheter aortic valve replacement. JAMA Cardiol. 2017;2:455–456. https://doi.org/10.1001/jamacardio.2016.4132.
22. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). European Heart Journal. 2020;41(1):111-188. https://doi.org/10.1093/eurheartj/ehz455
23. Genereux P, Stone GW, O’Gara PT, Marquis-Gravel G, Redfors B, Giustino G, et al. Natural history, diagnostic approaches, and therapeutic strategies for patients with asymptomatic severe aortic stenosis. J Am Coll Cardiol. 2016;67:2263–2288. https://doi.org/10.1016/j.jacc.2016.02.057
24. Dahl JS, Videbaek L, Poulsen MK, Rudbaek TR, Pellikka PA, Moller JE. Global strain in severe aortic valve stenosis: relation to clinical outcome after aortic valve replacement. Circ Cardiovasc Imaging. 2012;5:613–620. https://doi.org/10.1161/CIRCIMAGING.112.973834
25. Rossebo AB, Pedersen TR, Boman K, Brudi P, Chambers JB, Egstrup K, et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med. 2008;359:1343–1356. https://doi.org/10.1056/NEJMoa0804602
26. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129–2200. https://doi.org/10.1093/eurheartj/ehw128.
27. Smith WT, Ferguson TB, Ryan T, Landolfo CK, Peterson ED. 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. 2004;44:1241–1247. https://doi.org/10.1016/j.jacc.2004.06.031
28. Hankey GJ, Patel MR, Stevens SR. Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of ROCKET AF. Lancet Neurol. 2012;11(4):315–322. https://doi.org/10.1016/S1474-4422(12)70042-X.
29. Halvorsen S, Atar D, Yang H, De Caterina R, Erol C, Garcia D, et al. Efficacy and safety of apixaban compared with warfarin according to age for stroke prevention in atrial fibrillation: Observations from the ARISTOTLE trial. European Heart Journal. 2014;35(28):1864-72. https://doi.org/10.1093/eurheartj/ehu046
30. Böhm M, Ezekowitz MD, Connolly SJ, Eikelboom JW, Hohnloser SH, Reilly PA, et al. Changes in renal function in patients with atrial fibrillation: an analysis from the RELY trial. J. Am. Coll. Cardiol. 2015;65(23):2481–2493. https://doi.org/10.1016/j.jacc.2015.03.577
31. Ye J, Cheung A, Yamashita M, Wood D, Peng D. Transcatheter aortic and mitral valve-in-valve implantation for failed surgical bioprosthetic valves: an 8-year single-center experience. JACC Cardiovasc Interv. 2015;8:1735–1744. https://doi.org/10.1016/j.jcin.2015.08.012
32. Butchart EG, Gohlke-Barwolf C, Antunes MJ, Tornos P, De Caterina R, Cormier B, et al. Recommendations for the management of patients after heart valve surgery. Eur Heart J. 2005;26(22):2463–2471. https://doi.org/10.1093/eurheartj/ehi426
33. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B. et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS: the Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC). Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC: endorsed by the European Stroke Organisation (ESO). Eur Heart J. 2016;37:2893 –2962. https://doi.org/10.1093/eurheartj/ehw210
34. Tsai YC, Phan K, Munkholm-Larsen S, Tian DH, La Meir M, Yan TD. Surgical left atrial appendage occlusion during cardiac surgery for patients with atrial fibrillation: a metaanalysis. Eur J Cardiothorac Surg. 2015;47:847–.854. https://doi.org/10.1093/ejcts/ezu291
Review
For citations:
Kryuchkova O.N., Itskova E.A., Lutai Yu.A., Turna E.U., Zhukova N.V., Kostyukova E.A. AORTIC STENOSIS, DIAGNOSIS, TREATMENT TACTICS. WHAT IS IMPORTANT FOR THE THERAPIST TO KNOW? South Russian Journal of Therapeutic Practice. 2020;1(1):50-55. (In Russ.) https://doi.org/10.21886/2712-8156-2020-1-1-50-55
Views:
1070
Email this article 