Abstract
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.
Keywords
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Article Info
Publication History
Published online: December 30, 2021
Footnotes
Funding: None.
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
© 2022 Published by Elsevier Inc.
