title: Markers of left ventricular decompensation in aortic stenosis.
abstract: Calcified aortic stenosis is a condition that affects the valve and the myocardium. As the valve narrows, left ventricular hypertrophy occurs initially as an adaptive mechanism to maintain cardiac output. Ultimately, the ventricle decompensates and patients transition towards heart failure and adverse events. Current guidelines recommend aortic valve replacement in patients with severe aortic stenosis and evidence of decompensation based on either symptoms or an impaired ejection fraction <50%. However, symptoms can be subjective and correlate only modestly with the severity of aortic stenosis whilst impaired ejection fraction is an advanced manifestation and often irreversible. In this review, the authors will discuss the pathophysiology of left ventricular hypertrophy and the transition to heart failure. Subsequently, the authors will examine novel biomarkers that may better identify the transition from hypertrophy to heart failure and therefore guide the optimal timing for aortic valve replacement.
authors.affiliation: BHF/Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
authors.forename: Calvin W L
authors.initials: CW
authors.lastname: Chin
authors.forename: Vassilis
authors.initials: V
authors.lastname: Vassiliou
authors.forename: William S A
authors.initials: WS
authors.lastname: Jenkins
authors.forename: Sanjay K
authors.initials: SK
authors.lastname: Prasad
authors.forename: David E
authors.initials: DE
authors.lastname: Newby
authors.forename: Marc R
authors.initials: MR
authors.lastname: Dweck
mesh_terms: D001024:Aortic Valve Stenosis / Q000150:complications / Q000503:physiopathology*; D015415:Biomarkers; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000503:physiopathology*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers
keywords: aortic stenosis; cardiac MRI; echocardiography; left ventricular decompensation; left ventricular hypertrophy; myocardial T1 mapping; myocardial fibrosis; myocyte death; tissue Doppler imaging