From the Guidelines
The current treatment approach for moderate aortic stenosis primarily involves regular clinical monitoring and management of symptoms rather than immediate valve intervention, with a focus on controlling cardiovascular risk factors and treating comorbidities, as recommended by recent guidelines 1.
Key Considerations
- Patients should undergo clinical evaluation every 1-2 years with echocardiography every 3-5 years to track disease progression.
- No specific medications directly treat the valve narrowing itself, but management focuses on controlling cardiovascular risk factors and treating comorbidities.
- Antihypertensive medications like ACE inhibitors or ARBs may be used cautiously at low doses for patients with hypertension, while avoiding excessive blood pressure reduction, with a target systolic blood pressure of 130–139 mmHg and a diastolic blood pressure of 70–90 mmHg 1.
- Beta-blockers should be used carefully as they may reduce cardiac output.
- Patients should maintain good dental hygiene and receive antibiotic prophylaxis before dental procedures to prevent endocarditis.
- Moderate physical activity is generally safe, but strenuous exercise should be avoided.
- Surgical or transcatheter valve replacement is typically reserved for severe stenosis or when patients develop symptoms like chest pain, syncope, or heart failure, as indicated by the latest European Society of Cardiology guidelines 1.
Rationale
The conservative approach is justified because moderate aortic stenosis typically progresses slowly, and the risks of intervention generally outweigh benefits until the disease becomes severe or symptomatic, as supported by studies on the natural history of aortic stenosis 1.
Recent Evidence
A recent study published in the European Journal of Heart Failure highlights the importance of optimizing the timing of intervention by careful symptom assessment, exercise stress testing, serial echocardiography, and management of comorbidities in patients with moderate aortic stenosis 1.
Recommendations
Based on the latest evidence, patients with moderate aortic stenosis should be managed conservatively, with a focus on controlling cardiovascular risk factors and treating comorbidities, and surgical or transcatheter valve replacement should be reserved for severe stenosis or symptomatic patients 1.
From the Research
Current Treatment Approach for Moderate Aortic Stenosis
The current treatment approach for moderate aortic stenosis involves:
- Clinical surveillance, with aortic valve replacement (AVR) considered if there is an indication for coronary revascularization 2
- Serial Doppler echocardiography every one to two years to monitor disease progression 3
- Medical management of concurrent hypertension, atrial fibrillation, and coronary artery disease to optimize outcomes 3
- Consideration of transcatheter aortic valve replacement (TAVR) in patients at high or prohibitive surgical risk 3
Risk Stratification and Management
Risk stratification is crucial in managing patients with moderate aortic stenosis, with consideration of:
- Left ventricular remodeling response using multimodality imaging 2
- Associated comorbidities and their impact on cardiovascular risk 2
- Potential benefits of early AVR in select patients 2
Ongoing Research and Trials
Ongoing trials are investigating the role of AVR in moderate aortic stenosis, with a focus on: