Aortic Stenosis - Diagnosis

AORTIC STENOSIS

Aortic Stenosis (AS) is the most common primary valve disease leading to surgery or catheter intervention in Europe and North America.¹ It is present in approximately 2% of the general population with a rising prevalence in the elderly (up to 6% in patients above 85 years old).^2-4

Symptomatic AS has significant effects on a patient’s health and quality of life^5,6 and many will have cardiovascular and other comorbidities, for example, other valvular diseases, diabetes mellitus, hypertension and peripheral vascular disease.^7-11

The three cardinal symptoms of AS are angina, syncope or heart failure (HF).^13,16Other symptoms include dyspnea and decreased exercise tolerance.¹⁴

Primary care physicians should consider AS in adults presenting with any of the cardinal symptoms and/or those who have specific signs of AS on auscultation.¹⁷

Severe AS is clinically detected by a reduced valve area and severe hemodynamic deterioration.^1,14

Exercise stress testing is recommended for risk stratification of asymptomatic AS patients. However, it is contraindicated in symptomatic
AS patients.¹⁸

ECHOCARDIOGRAPHY is the primary diagnostic modality to diagnose AS, with doppler echocardiography being the preferred technique to determine the severity of AS.¹⁸ Echocardiography also provides information that is relevant for assessing the prognosis of AS and making therapeutic decisions,
e.g. the need and urgency of valve intervention.¹⁸

CARDIAC MAGNETIC RESONANCE IMAGING (MRI) may be helpful to further assess the dimensions and geometry of the ascending aorta and the degree of valve calcification.¹⁸

MULTI-SLICE COMPUTED TOMOGRAPHY (MSCT) may be helpful to further assess the dimensions and geometry of the ascending aorta and the degree of valve calcification. It is also the preferred imaging tool for preprocedural patient evaluation and bioprosthetic valve sizing when Transcatheter Aortic Valve Implantation (TAVI) is considered.¹⁸

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References

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