Improvement of the characterization and risk-stratification of patients with moderate aortic stenosis

Abstract

The objectives of the current thesis were i) to explore the pathogenesis of moderate AS, ii) to evaluate the associated changes in myocardial structure and function in patients with moderate AS, and iii) to determine the long-term prognostic implications of moderate AS on all-cause mortality and AVR. Chapter 2 investigates the prevalence and prognostic implications of discordant grading, and describes different types of flow-gradient patterns in patients with moderate AS. Chapter 3 focuses on the long-term outcomes of patients with moderate AS according to LVEF and symptom severity. In chapter 4, results are presented on the relationship between LV diastolic dysfunction and outcomes in patients with moderate AS. In chapter 5, the prevalence of different LV remodeling patterns and their role in predicting outcome are discussed. The prognostic role of LV GLS, as well as its incremental value over LVEF in patients with moderate AS having preserved, as well as reduced LV systolic function, is discussed in chapter 6 and 7. Chapter 8 analyzes the sex-related differences that are observed in patients with moderate AS. Changes in myocardial structure and function that accompany the progression of moderate to severe AS are explained in chapter 9. Finally, chapter 10 provides an overview on how multimodality imaging can help to correctly diagnose moderate AS and improve the evaluation of the LV remodeling response. It also reviews the current evidence on the management of moderate AS and highlights the ongoing trials on AVR in this patient population.