Severe Aortic Stenosis; More Than an Imaging Diagnosis

Author Department

Cardiology; Medicine

Document Type

Article, Peer-reviewed

Publication Date



The definition of severe aortic stenosis has undergone significant change casting a wider net to avoid missing patients who could benefit from valve replacement. The presence or absence of symptoms remains the key decision-making element, however individuals presently undergoing evaluation are older, more likely asymptomatic, and have lower gradients. Due to numerous potential measurement errors, attention to detail when performing diagnostic testing, and understanding their limitations, are necessary to render appropriate treatment. Exercise testing adds useful information for individuals with severe aortic stenosis felt to be asymptomatic. Dobutamine echocardiography, in low flow-low gradient aortic stenosis, distinguishes between a myopathic and valvular cause of left ventricular dysfunction. Evaluation of patients when normotensive minimizes measurement errors. The amount of aortic valve calcification adds useful information when the degree of aortic stenosis is uncertain. A good history and physical integrated with high quality imaging data allows for appropriate clinical treatment decisions for patients with aortic stenosis. The goal is simultaneously to provide aortic valve replacement for patients in need while avoiding overdiagnosis and performance of unnecessary procedures. CLINICAL SIGNIFICANCE: : The number of patients undergoing isolated aortic valve replacement nearly tripled between 2012 and 2019., Hemodynamic evaluation of aortic stenosis has numerous potential measurement errors., Aortic valve replacement decisions have historically been based on symptoms. Patients evaluated in the present era are older and less likely symptomatic., Integration of all clinical data with attention to hemodynamic measurements detail is essential to identify patients who will benefit from aortic valve replacement.

Keywords: Aortic Valve Area; Asymptomatic Aortic Stenosis; Low Gradient Aortic Stenosis; Severe Aortic Stenosis.