Aortic Valve Stenosis: Progress from Diagnosis to Treatment

TL;DR

Aortic stenosis is a common heart condition in older adults, requiring advanced imaging and specialized treatments like valve replacement to manage its progression and complications.

Contribution

The paper highlights the integration of multimodality imaging and tailored interventional strategies to improve outcomes in aortic stenosis management.

Findings

Transthoracic echocardiography is central for diagnosing aortic stenosis but often requires advanced imaging for accurate severity assessment.

Treatment primarily involves interventional procedures like SAVR and TAVR, as medical therapy cannot halt disease progression.

Special cases like cardiogenic shock require individualized, multidisciplinary approaches for effective management.

Abstract

Aortic stenosis (AS) is the most prevalent valvular heart disease in Western countries and it is especially associated with older age. With its progressive course, AS leads to ventricular hypertrophy, impaired diastolic and systolic function, and symptomatic deterioration. The natural history of AS is closely linked to the extent of myocardial and extracardiac damage in association with the patients comorbidities. Diagnosis relies primarily on transthoracic echocardiography, which assesses valve morphology, quantifies stenosis severity, and evaluates cardiac remodeling. However, discordant grading is frequent, necessitating advanced imaging to clarify the severity and the mechanism of the stenosis and stratify risk. Treatment is predominantly interventional, as no medical therapy is able to stop disease progression. Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are the two treatment options. Special clinical scenarios—such as cardiogenic shock or concomitant cardiac amyloidosis—pose additional diagnostic and therapeutic challenges and require individualized, multidisciplinary management. Overall, contemporary AS care increasingly integrates multimodality imaging, refined risk stratification, and tailored interventional strategies to optimize outcomes.

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