We searched PubMed with the keyword “aortic stenosis”. We identified citations that formed a mix of important older studies and those published since 2000. Citations from journals with high impact factors were given special weight, and we attempted to balance sources from the USA and Europe.
ReviewAortic stenosis
Section snippets
Epidemiology
Aortic valvular abnormalities are quite frequent in old patients. In the Cardiovascular Health Study, in which 5201 men and women older than 65 years were examined, 26% of study participants had aortic sclerosis (a thickening of the valve or calcification without significant obstruction). A slight predominance of the disorder was noted in men. 2% of all patients had frank aortic stenosis.1 A clear increase in prevalence of sclerosis was seen with age: 20% in patients aged 65–75 years, 35% in
Calcific aortic stenosis
Once judged a degenerative disease, the mechanism by which a previously healthy tricuspid aortic valve becomes stenotic is now believed to be very similar to that of atherosclerosis. The initial plaque of aortic stenosis is alike that of coronary artery disease.2 Risk factors associated with coronary artery disease—including age, male sex, hyperlipidaemia, and evidence of active inflammation—are held in common by the two disorders.3 Further, there is a high coincidence of both diseases in the
Pathophysiology and relation to symptoms
Onset of severe symptoms of aortic stenosis—angina, syncope, and heart failure—remains the major demarcation point in the disease's course (figure 1).19 The asymptomatic patient has a good outlook even with severe obstruction, whereas an individual with symptoms has a mortality rate of about 25% per year. Thus, knowing how the pathophysiology of aortic stenosis causes symptoms and death is paramount to understanding the disease.
Physical examination
Aortic stenosis is usually detected initially by auscultation that indicates the typical crescendo-decrescendo systolic ejection murmur radiating to the neck. In mild disease, the murmur peaks early in systole, S2 is physiologically split, and carotid upstrokes are normal. This condition—in which a thickened valve causes no appreciable obstruction to outflow—is termed aortic sclerosis. Although by itself benign, presence of aortic sclerosis is associated with a substantial increase in risk for
Medical treatment
Severe symptomatic aortic stenosis is a lethal obstruction to outflow that needs effective mechanical relief in the form of valve replacement for most patients. No medical treatment is effective for chronic disease. However, as noted above (see section on Causes), modern ideas about valve pathology (rather than the effects of stenosis on the heart and body) indicate that aortic stenosis is caused by an active inflammatory process akin to that of atherosclerosis.60, 61 Thus unsurprisingly,
Conclusions and future work
Symptomatic severe aortic stenosis is a fatal disease when treated medically, but after aortic valve replacement a patient's lifespan returns to near that of an unselected population.94 Even individuals with advanced disease and left-ventricular dysfunction can have a good outcome, especially when the reason for the dysfunction is a large transvalvular gradient causing high afterload. In people with aortic stenosis and a low gradient and low ejection fraction, prognosis is worse but is still
Search strategy and selection criteria
References (94)
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Association of coronary risk factors and use of statins with progression of mild valvular aortic stenosis in older persons
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Relation of aortic valve sclerosis to risk of coronary heart disease in African-Americans
Am J Cardiol
(2005) - et al.
Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis
J Am Coll Cardiol
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Orifice variability of the stenotic aortic valve: evaluation before and after balloon aortic valvuloplasty
J Am Coll Cardiol
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Left ventricular wall stress in compensated aortic stenosis in children
Am J Cardiol
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Syncope and sudden death in aortic stenosis
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Syncope in aortic valvular stenosis
Lancet
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Usefulness of an elevated B-type natriuretic peptide in predicting survival in patients with aortic stenosis treated without surgery
Am J Cardiol
(2005)