Should early elective surgery be performed in patients with severe but asymptomatic aortic stenosis?

Department of Cardiology, Vienna General Hospital, University of Vienna, Vienna, Austria.
European Heart Journal (Impact Factor: 15.2). 10/2002; 23(18):1417-21. DOI: 10.1053/euhj.2002.3163
Source: PubMed
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    • "Conversely, patients who become symptomatic are at significant risk of developing adverse cardiac events while waiting for surgery, and peri-operative risk increases significantly with the severity of symptoms. (Rosenhek et al., 2002) These factors contribute to the controversy on the optimal timing of AVR in asymptomatic severe AS, because the risk of potential adverse cardiac complications from AS must be weighed against the risk of surgery in truly asymptomatic patients. A non-invasive marker of early cardiac decompensation could be useful to risk stratify asymptomatic AS patients into those likely to derive benefit from surgery before the development of symptoms or irreversible LV impairment, from those who have a low risk of adverse events during follow-up. "
    Aortic Stenosis - Etiology, Pathophysiology and Treatment, 10/2011; , ISBN: 978-953-307-660-7
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    • "However, as soon as symptoms occur, such as exertional dyspnoea, angina, and syncope, outcome becomes poor. Average survival after the onset of symptoms has been reported to be less than 2–3 years [4]. In this situation, valve replacement does not only result in dramatic symptomatic improvement but also in good long term survival [5]. "
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    ABSTRACT: Aortic stenosis (AS) is the most frequent valvular heart disease. Severe AS results in concentric left ventricular hypertrophy, and ultimately, the heart dilates and fails. During a long period of time patients remain asymptomatic. In this period a pathology progression should be monitored and effectively thwarted by targeted measures. A cascade of cellular and molecular events leads to chronic degeneration of aortic valves. There are some molecular attributes characteristic for the process of valvular degeneration with clear functional link between shifted cell-cycle control, calcification and tissue remodelling of aortic valves. Bioactivity of implanted bioprosthesis is assumed to result in its dysfunction. Age, gender (females), smoking, Diabetes mellitus, and high cholesterol level dramatically shorten the re-operation time. Therefore, predictive and preventive measures would be highly beneficial, in particular for young female diabetes-predisposed patients. Molecular signature of valvular degeneration is reviewed here with emphases on clinical meaning, risk-assessment, predictive diagnosis, individualised treatments.
    EPMA Journal, The 03/2011; 2(1):91-105. DOI:10.1007/s13167-011-0072-3
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    • "Symptoms assessment, however, is frequently difficult, especially in elderly patients with aortic stenosis because of reduction of physical activity or under-reporting by the patients themselves. Furthermore, there is a wide overlap in all echocardiographic and hemodynamic measurements between symptomatic and asymptomatic patients [5] [6] [7]. Recent studies have shown that plasma levels of natriuretic peptides, well recognized markers of left ventricular hypertrophy and dysfunction in patients with congestive heart failure [8] [9], are also related to disease "
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    ABSTRACT: Brain natriuretic peptide (BNP) is related to symptomatic status and outcome in aortic stenosis (AS) patients. Carbohydrate antigen 125 (CA125) demonstrated recently a BNP-like behaviour in patients with congestive heart failure (CHF) but has never been studied in AS patients. We aimed to assess the role of CA125 and BNP in AS patients. CA125 and BNP blood levels, transthoracic echocardiography and independent evaluation of CHF symptoms were obtained in 64 consecutive patients (76+/-9 years; 35 males) with AS (valve area 0.9+/-0.3 cm(2)). A pre-specified combined end-point consisting of cardiac mortality, urgent aortic valve replacement and hospitalization for CHF was considered. The median follow-up was 8 months (interquartile range 4.5-10 months). Both CA125 and BNP have accurately identified patients with III-IV NYHA class: area under the ROC curve was 0.85 for CA125 and 0.78 for BNP (best cut-offs of 10.3 U/mL and 254.64 pg/mL respectively) and were independently correlated to left ventricular ejection fraction. Fifty-two percent of patients with CA125>or=10.3 U/mL vs. 13% with CA125<10.3 U/mL (p<0.01) and 65% patients with BNP>or=254 pg/mL vs. 7% with BNP<254 pg/mL (p<0.001) have reached the end-point. Both CA125 and BNP levels are significantly correlated with NYHA class and outcome in patients with AS. CA125 blood level assessment (less expensive) may improve the clinical management in this setting.
    International journal of cardiology 07/2007; 128(3):406-12. DOI:10.1016/j.ijcard.2007.05.039 · 4.04 Impact Factor
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