From the Guidelines
The recommended screening interval for aortic stenosis is every 6 months for asymptomatic severe cases, yearly for mild and moderate cases with significant calcification, and every 2 to 3 years for younger patients with mild aortic stenosis and no significant calcification. When determining the screening interval, several factors should be considered, including the severity of the condition, the presence of symptoms, and the rate of disease progression.
- For asymptomatic severe aortic stenosis, regular monitoring is crucial to detect any changes in symptoms or echo parameters, and measurement of natriuretic peptides may be considered 1.
- In cases with significant calcification, more frequent monitoring is necessary, with yearly evaluations for mild and moderate aortic stenosis.
- For younger patients with mild aortic stenosis and no significant calcification, less frequent monitoring may be sufficient, with intervals extended to 2 to 3 years. The frequency of monitoring should be determined on the basis of the initial examination, taking into account the individual's risk profile and anatomic suitability 1. Regular screening is essential to allow for timely intervention before complications develop, as aortic stenosis typically progresses gradually over time. Clinical assessment should accompany each echocardiographic evaluation to monitor for symptom development, which would indicate the need for valve replacement consideration. The progression rate tends to be faster in patients with calcific aortic stenosis, bicuspid aortic valves, advanced age, and those with cardiovascular risk factors such as hypertension and hyperlipidemia. In the presence of symptoms such as chest pain, shortness of breath, or syncope, immediate evaluation is warranted regardless of the previous screening schedule.
From the Research
Screening Interval for Aortic Stenosis
The recommended screening interval for aortic stenosis varies based on the severity of the disease.
- For severe aortic stenosis, serial Doppler echocardiography is recommended every six to 12 months 2, 3.
- For moderate disease, serial Doppler echocardiography is recommended every one to two years 2, 3.
- For mild disease, serial Doppler echocardiography is recommended every three to five years 2, 3.
Rationale for Screening
The rationale for these screening intervals is to monitor the progression of the disease and to identify patients who may benefit from early intervention, such as aortic valve replacement 4.
Importance of Guideline Adherence
Adherence to these screening guidelines is important, as it has been shown to be associated with improved survival and reduced adverse clinical events in patients with asymptomatic severe aortic stenosis 5.
Considerations for Screening Programs
There is also a call to consider an aortic stenosis screening program for high-risk individuals, including those over 75 years of age and those with dialysis-dependent end-stage renal disease 6.