title: Optimal timing of valve replacement in asymptomatic severe aortic stenosis.
abstract: Patients with asymptomatic severe aortic stenosis (AS) constitute a heterogeneous group which includes not only certain cases who are at high risk of sudden death and valve-related heart failure, but also those at low risk for these events. Degenerative AS, which includes a majority of patients with AS, is characterized by stricture of the valve, increased arterial stiffness, and diverse left ventricular response to the valvular plus arterial vascular load. In addition to using traditional primary parameters, the severity of AS and the total left ventricular load should be assessed using new measures such as energy loss index and valvulo-arterial impedance. Natriuretic peptide levels and global longitudinal strain imaging may also be used as secondary parameters to obtain information about left ventricular systolic function, although these parameters do not correlate with the severity of AS. Exercise stress testing and exercise echocardiography are also beneficial when assessing the patient if they are symptomatic, and for determining valvular and left ventricular contractile reserves. The aim of this review was to emphasize the importance of risk stratifications in asymptomatic severe AS cases, and to assess the severity of AS using not only conventional methods but also new methods on which much emphasis has been placed during recent years.
authors: Emine
authors: E
authors: Bilen
authors: Gökürk
authors: G
authors: Ipek
authors: Huseyin
authors: H
authors: Ayhan
authors: Alper Bugra
authors: AB
authors: Nacar
authors: Haci Ahmet
authors: HA
authors: Kasapkara
authors: Cenk
authors: C
authors: Sani
authors: Serdar
authors: S
authors: Basbug
authors: Mustafa
authors: M
authors: Kurt
authors: Engin
authors: E
authors: Bozkurt
mesh_terms: D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D058070:Asymptomatic Diseases / Q000628:therapy; D015415:Biomarkers / Q000032:analysis; D002114:Calcinosis / Q000175:diagnosis; D003645:Death, Sudden / Q000209:etiology; D005080:Exercise Test; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology
chemical_list: D015415:Biomarkers