Managing Patients With Moderate Aortic Stenosis.

Current guidelines recommend that clinical surveillance for patients with moderate aortic stenosis (AS) and aortic valve replacement (AVR) may be considered if there is an indication for coronary revascularization. Recent observational studies, however, have shown that moderate AS is associated with an increased risk of cardiovascular events and mortality. Whether the increased risk of adverse events is caused by associated comorbidities, or to the underlying moderate AS itself, is incompletely understood. Similarly, which patients with moderate AS need close follow-up or could potentially benefit from early AVR is also unknown. In this review, the authors provide a comprehensive overview of the current published reports on moderate AS. They first provide an algorithm that helps to diagnose moderate AS correctly, especially when discordant grading is observed. Although the traditional focus of AS assessment has been on the valve, it is increasingly acknowledged that AS is not only a disease of the aortic valve but also of the ventricle. The authors therefore discuss how multimodality imaging can help to evaluate the left ventricular remodeling response and improve risk stratification in patients with moderate AS. Finally, they summarize current evidence on the management of moderate AS and highlight ongoing trials on AVR in moderate AS.

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Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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Funding Support and Author Disclosures Dr Stassen has received funding from the European Society of Cardiology (ESC Training Grant App 000064741). Dr Pio has received funding from the European Society of Cardiology (ESC Training Grant T-2018-17405). The Department of Cardiology of the Leiden University Medical Centre has received unrestricted research grants from Abbott Vascular, Bayer, Biotronik, Bioventrix, Boston Scientific, Edwards Lifesciences, GE Healthcare, and Medtronic. Dr Ewe has received speaker fees from Abbott Vascular, Philips, and GE Healthcare. Dr Pibarot has received funding from Edwards Lifesciences, Medtronic, Pi-Cardia, and Cardiac Phoenix for echocardiography core laboratory analyses and research studies in the field of transcatheter valve therapies, for which he received no personal compensation; and he has received speaker fees from Edwards Lifesciences and Medtronic. Dr Leipsic holds institutional core laboratory grants with Edwards Lifesciences, Medtronic, Abbott, Boston Scientific, Conformal, Neovasc, and Pi Cardia; and is a consultant to Circle CVI. Dr Genereux has served as consultant and advisor and has received speaker fees from Abiomed and BioTrace Medical; has served as consultant for Boston Scientific, Cardiovascular System Inc, and the PI Eclipse Trial; has served as consultant and advisor, received speaker fees, and served as proctor for Edwards Lifesciences, from whom he has received research grants for the PI EARLY-TAVR and PI PROGRESS trials; has served as consultant for GE Healthcare, Siemens, Teleflex, and iRhythm Technologies; has served as consultant and advisor to Medtronic and has received speaker fees; has served as consultant to Opsens; has served as consultant and holds equity in Pi-Cardia, Puzzle Medical, and Saranas; has served as consultant and has received speaker fees from Shockwave; has served as consultant and holds equity in Soundbite Medical Inc; and has served as consultant, and as feasibility study PI for 4C Medical. Dr Van Mieghem has received research grant support from Abbott Vascular, Biotronik, Boston Scientific, Medtronic, Edwards Lifesciences, Abiomed, PulseCath BV, Daiichi Sankyo, Pie Medical, and Siemens. Dr Makkar has received consultant and research grants from Edwards, Medtronic, Abbott, Boston Scientific, and Philips. Dr Hahn has received speaker fees from Abbott Vascular, Baylis Medical, and Edwards Lifesciences; institutional consulting for Abbott Structural, Edwards Lifesciences, Medtronic; equity with Navigate; and is Chief Scientific Officer for the Echocardiography Core Laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored trials, for which she receives no direct industry compensation. Dr Playford has received unrestricted research grants from Edwards Lifesciences, Janssen, Novartis, and Pfizer; and has received speaker fees from Edwards Lifesciences. Dr Ajmone Marsan has received speaker fees from Abbott Vascular and GE Healthcare. Dr Delgado has received speaker fees from Abbott Vascular, Edwards Lifesciences, Medtronic, Novartis, Merck Sharp & Dohme, and GE Healthcare. Dr Leon has received institutional clinical research grants from Abbott, Boston Scientific, Edwards, and Medtronic. Dr Bax has received speaker fees from Abbott Vascular. All other authors have no relationships relevant to the contents of this paper to disclose.