Natural history, epidemiology, and prognosis of aortic stenosis
- William H Gaasch, MD
William H Gaasch, MD
- Section Editor — Valvular Disease
- Professor of Medicine
- University of Massachusetts Medical School
- Tufts University School of Medicine
- Senior Consultant in Cardiology
- Lahey Clinic
Aortic valve stenosis (AS, aortic stenosis) is the most common cause of left ventricular outflow obstruction in children and adults; less common causes are subvalvular or supravalvular disease (table 1).
The epidemiology and natural history of AS will be reviewed here. The clinical features, diagnosis, evaluation, medical therapy, percutaneous aortic valvotomy, transcatheter aortic valve replacement, and surgical aortic valve replacement for AS are discussed separately. (See "Clinical manifestations and diagnosis of aortic stenosis in adults" and "Medical management of asymptomatic aortic stenosis in adults" and "Indications for valve replacement in aortic stenosis in adults".)
Aortic valve sclerosis is defined as aortic valve thickening and calcification without a significant gradient (defined as an aortic jet velocity <2 m/sec). Aortic stenosis (AS) is present when the antegrade velocity across an abnormal valve is at least 2 m/sec. The stages of AS are defined by symptoms, valve anatomy, valve hemodynamics, and left ventricular function (table 2). (See "Aortic valve sclerosis and pathogenesis of calcific aortic stenosis" and "Clinical manifestations and diagnosis of aortic stenosis in adults" and "Echocardiographic evaluation of the aortic valve".)
Severe AS is defined as AS with a maximum aortic transvalvular velocity ≥4 m/s with typically an aortic valve area ≤1 cm2. Very severe AS is present when the Doppler aortic jet velocity is ≥5 m/sec (table 3). (See "Aortic valve area in aortic stenosis", section on 'Critical valve area and severity'.)
The term “symptomatic AS” refers to AS that is causing cardiac symptoms. End-stage symptoms include heart failure, anginal chest discomfort, and syncope. However, the most common symptoms in patients who are followed prospectively are decreased exercise tolerance, or dyspnea on exertion. (See "Clinical manifestations and diagnosis of aortic stenosis in adults", section on 'Symptoms'.)
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- ETIOLOGY OF AORTIC STENOSIS
- PROGRESSION OF AORTIC STENOSIS
- Observational studies
- - Overview
- - University of Washington
- - Medical University of Vienna
- - Mayo Clinic
- Risk factors for progression
- - Effect of cause of AS
- PROGNOSIS OF SYMPTOMATIC AS
- Pulmonary hypertension
- INFORMATION FOR PATIENTS