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Clinical Advancement in Aortic Valve Stenosis
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Clinical Advancement in Aortic Valve Stenosis

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (25 June 2024) | Viewed by 4076

Special Issue Editors

Prof. Dr. Attila Kardos

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Guest Editor
Translational Cardiovascular Research Group, Department of Cardiology, Milton Keynes University Hospital NHS Trust, Milton Keynes, UK
Interests: integrated cardiovascular imaging; cardiac CT; echocardiography; CMR; coronary artery disease; ischemia; AI in cardiac image acquisition and analysis
Dr. Tarun Mittal

E-Mail Website
Guest Editor
1. Heart Division, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
2. Faculty of Medicine, National Heart & Lung Institute, Imperial College London, London, UK
Interests: imaging of coronary heart disease; risk assessment; ventricular assist devices; heart failure; aortic valve disease; heart and lung transplantation

Special Issue Information

Dear Colleagues,

The understanding of the impact of aortic valve stenosis on outcome irrespective of its severity has changed since the advent of populational databases on AS since the landmark publication by Ross and Braunwald in 1968. The pathophysiology of AS, like that of atherosclerosis, constitutes an exciting field for research. The available interventions once AS reaches a severe grade is also evolving from open-heart to keyhole surgical techniques. The timing of intervention and association with survival is a matter of active debate. This Special Issue on AS is dedicated to review evidence and helps in understanding the best diagnostic and therapeutic strategies (including echocardiography, cardiac CT, cardiac MRI, risk factor management, and novel anti-inflammatory agents to minimally invasive surgery). 

Prof. Dr. Attila Kardos
Dr. Tarun Kumar Mittal
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • aortic stenosis
  • diagnostic strategies
  • therapeutic options
  • timing of intervention
  • minimally invasive surgery

Published Papers (5 papers)

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Research

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10 pages, 1350 KiB  
Article
Does Atrial Fibrillation at Diagnosis Change Prognosis in Patients with Aortic Stenosis?
by Olga Petrovic, Stasa Vidanovic, Ivana Jovanovic, Ivana Paunovic, Ivana Rakocevic, Dejan Milasinovic, Milorad Tesic, Nikola Boskovic, Djordje Dukic, Marina Ostojic, Jelena Vratonjic, Aleksandra Mladenovic and Danijela Trifunovic-Zamaklar
J. Clin. Med. 2024, 13(13), 3917; https://doi.org/10.3390/jcm13133917 - 4 Jul 2024
Viewed by 388
Abstract
Background: Aortic stenosis (AS) is a common valve disease and atrial fibrillation (AF) is the most common cardiac arrhythmia, frequently associated with AS. This study aimed to evaluate the impact of AF on mortality in patients with moderate and severe AS. Methods: We [...] Read more.
Background: Aortic stenosis (AS) is a common valve disease and atrial fibrillation (AF) is the most common cardiac arrhythmia, frequently associated with AS. This study aimed to evaluate the impact of AF on mortality in patients with moderate and severe AS. Methods: We retrospectively analyzed 1070 consecutive moderate and severe AS patients (57% were male, age was 69 ± 10, severe AS 22.5%), who underwent transthoracic echocardiography from March 2018 to November 2021. AS severity was defined by specific threshold values with severe AS being defined by a peak velocity > 4 m/s, an MPG > 40 mmHg, and an AVA < 1 cm2 and moderated by a peak velocity of 3–4 m/s, an MPG 20–40 mmHg and an AVA 1–1.5 cm. Patients with AF were defined as those having a history of AF when AS was found on the index echocardiography. The follow-up assessment in December 2023 ascertained vital status and data on aortic valve replacement (AVR). Results: 790 (73.8%) patients were with sinus rhythm (SR) and 280 (26.2%) patients with AF. Mortality was higher in patients with AF than in those with SR (46% vs. 36.2% HR 1.424, 95% CI 1.121–1.809, p = 0.004). After adjusting for clinical confounders, mortality risk in AF relative to SR remained significant (HR 1.284, 95% CI 1.03–1.643, p = 0.047). Patients with AF demonstrated high mortality risk in the moderate aortic stenosis stratum (HR 1.376, 95% CI 1.059–1.788, p = 0.017), with even greater risk in the severe AS stratum (HR 1.644, 95% CI 1.038–2.603, p = 0.034) with significant interaction (p = 0.007). In patients with AF AVR demonstrated a protective effect on survival (HR 0.365, 95% CI 0.202–0.627, p < 0.001), but to a lesser degree than in patients with sinus rhythm (HR 0.376, 95% CI 0.250–0.561, p < 0.001) without significant interaction (p = 0.278). In patients with AF mortality risk was high in the conservative treatment stratum (HR 1.361, 95% CI 1.066–1.739, p = 0.014), in the AVR stratum mortality risk was higher but did not reach statistical significance (HR 1.823, 95% CI 0.973–3.414, p = 0.061). However, when corrected for echocardiographic variables strongly correlated with AF, AF was no longer independently associated with all-cause mortality. (HR 0.97 95% CI 0.709–1.323, p = 0.84). Conclusions: Patients with moderate and severe AS and AF have worse prognosis than patients with SR which can be explained by cardiac damage. AVR improves survival in patients with AF and with SR. Full article
(This article belongs to the Special Issue Clinical Advancement in Aortic Valve Stenosis)
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14 pages, 1842 KiB  
Article
Prognostic Impact of Left Ventricular Ejection Fraction Improvement after Transcatheter Aortic Valve Replacement
by Jakob Johannes Reichl, Thorald Stolte, Shihui Tang, Jasper Boeddinghaus, Max Wagener, Gregor Leibundgut, Christoph Ado Kaiser and Thomas Nestelberger
J. Clin. Med. 2024, 13(13), 3639; https://doi.org/10.3390/jcm13133639 - 21 Jun 2024
Viewed by 368
Abstract
Introduction: Transcatheter aortic valve replacement (TAVR) has become an efficient and safe alternative to surgical aortic valve replacement (SAVR). While severe aortic stenosis as well as severe aortic regurgitation (AR) are known to negatively impact left ventricular ejection fraction (LVEF), prior studies [...] Read more.
Introduction: Transcatheter aortic valve replacement (TAVR) has become an efficient and safe alternative to surgical aortic valve replacement (SAVR). While severe aortic stenosis as well as severe aortic regurgitation (AR) are known to negatively impact left ventricular ejection fraction (LVEF), prior studies have shown that TAVR can lead to an improvement in LVEF. Thus far, little is known about the prognostic implication of LVEF improvement as a sole predictor of outcomes. Therefore, the aim of this study was to assess the prognostic impact of LVEF impairment before TAVR, as well as early LVEF improvement in patients undergoing TAVR. Materials and Methods: Patients undergoing TAVR in a large tertiary university hospital were consecutively included in a prospective registry. Transthoracic echocardiography (TTE) was performed at baseline, after 1 month and annually thereafter. Significant LVEF improvement was defined as a relative increase of ≥10% in LVEF at 30 days compared to baseline LVEF. The primary outcome was all-cause mortality at 1 year. Secondary outcomes were major adverse cardiovascular events (MACEs) including cardiovascular death, non-fatal myocardial infarction, stroke, bleeding and unplanned re-interventions of the aortic valve at 5 years. Results: Among 1655 patients who underwent TAVR between September 2011 and April 2024, the LVEF at baseline was available for 1556 patients. Of these, 1031 patients (66.2%) had preserved LVEF at baseline (LVEF ≥ 53%), whereas 303 patients (19.5%) had moderately reduced LVEF (40–52%) and 222 patients (14.3%) had severely reduced LVEF (<40%). Out of the patients with impaired LVEF, 155 (40.4%) patients showed a significant improvement in LVEF ≥10% after 30 days, while 229 (60.6%) patients showed no significant LVEF improvement (<10%). Patients with preserved LVEF at baseline had significantly better mortality outcomes than those with severely reduced LVEF (p < 0.001). LVEF improvement was associated with a survival benefit after 1 year (p = 0.009, HR 2.68, 0.95 CI 1.23–5.85) which diminished after 5 years (p = 0.058), but patients with LVEF improvement showed lower MACE rates at 5 years (p < 0.001). Conclusions: Preserved LVEF before TAVR is an independent predictor for improved outcomes. Additionally, early improvement in LVEF is associated with beneficial outcomes in patients undergoing TAVR. Full article
(This article belongs to the Special Issue Clinical Advancement in Aortic Valve Stenosis)
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11 pages, 2144 KiB  
Article
Prognostic Relevance of Global Myocardial Work Index in Patients with Moderate Aortic Valve Stenosis
by Joscha Kandels, Michael Metze, Andreas Hagendorff and Stephan Stöbe
J. Clin. Med. 2023, 12(24), 7694; https://doi.org/10.3390/jcm12247694 - 14 Dec 2023
Viewed by 776
Abstract
Background: A reduced global myocardial work index (GWI) ≤ 1951 mmHg% is associated with increased mortality in patients with severe aortic valve stenosis (AS). However, parameters predicting the outcome in patients with moderate AS are limited. Therefore, the aim of this study was [...] Read more.
Background: A reduced global myocardial work index (GWI) ≤ 1951 mmHg% is associated with increased mortality in patients with severe aortic valve stenosis (AS). However, parameters predicting the outcome in patients with moderate AS are limited. Therefore, the aim of this study was to evaluate the prognostic value of the GWI in patients with moderate AS. Methods and Results: In this prospective study, 103 patients with moderate AS (mean age 72 ± 10 years; male: 69%) underwent standardized transthoracic echocardiography. The primary endpoint was survival without an aortic valve replacement (AVR). After a median follow-up of 30 ± 5 months, 37 patients (36%) were referred for an AVR. Survival without an AVR was 96% at 12 months and 80% at 30 months (>1951 mmHg%) versus 96% and 68% (≤1951 mmHg%). A GWI ≤ 1951 mmHg% did not predict the need for an AVR (hazard ratio 1.31 (95% CI, 0.63–2.72), p = 0.49). Furthermore, there was no significant correlation between the mean GWI (1644 ± 448 mmHg%) and mean aortic valve pressure gradient (24.2 mmHg ± 6.2, p = 0.615) or effective aortic orifice area (1.24 cm2 ± 0.11, p = 0.678). There was no difference between the AVR and non-AVR groups in the occurrence of clinical symptoms. Conclusion: In contrast to patients with severe AS, a GWI ≤ 1951 mmHg% did not predict the need for an AVR. Further research is needed to improve the risk stratification in patients with moderate AS. Full article
(This article belongs to the Special Issue Clinical Advancement in Aortic Valve Stenosis)
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10 pages, 1006 KiB  
Article
Sex Differences in Clinical Outcomes after Aortic Valve Intervention for Isolated Severe Aortic Stenosis
by Teresa Sevilla, Noemí Ramos, Manuel Carnero, Ignacio J. Amat-Santos, Manuel Carrasco-Moraleja, Ana Revilla, Isidre Vilacosta and J. Alberto San Román
J. Clin. Med. 2023, 12(22), 7025; https://doi.org/10.3390/jcm12227025 - 10 Nov 2023
Cited by 1 | Viewed by 813
Abstract
There are known pathophysiologic and clinical differences according to sex in patients with aortic stenosis (AS). To evaluate if these differences persist after valve replacement, we conducted an observational study including 451 patients with symptomatic AS who survived aortic valve intervention (AVI) in [...] Read more.
There are known pathophysiologic and clinical differences according to sex in patients with aortic stenosis (AS). To evaluate if these differences persist after valve replacement, we conducted an observational study including 451 patients with symptomatic AS who survived aortic valve intervention (AVI) in two centers. Clinical data and mortality were evaluated at a mean follow-up of 5 years. 56% of patients were women. At baseline, women were older (80.6 vs. 78 years, p = 0.013), presented higher mean gradient (48 vs. 45 mmHg, p = 0.023), lower aortic valve area (0.70 vs. 0.74 cm2, p = 0.002) and higher systolic pulmonary artery pressure (36 vs. 33 mmHg, p = 0.016). They underwent percutaneous aortic valve replacement more frequently than men (47 vs. 35.9%, p = 0.017). At 5 years follow-up, women required more admissions due to heart failure (23 vs. 9%, p = 0.046) but they did not present higher cardiovascular nor overall mortality (27.7% vs. 29.8%, p = 0.741; 11.1 vs. 10.1%, p = 0.619, respectively). Female sex was an independent predictor of heart failure hospitalization at follow-up (HR 95% 1.16–4.22, p = 0.016). Women undergo AVI at a more advanced stage than men, resulting in a higher frequency of readmissions due to heart failure during the follow-up period, but not in higher mortality. Full article
(This article belongs to the Special Issue Clinical Advancement in Aortic Valve Stenosis)
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Review

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16 pages, 1262 KiB  
Review
Influence of Aortic Valve Stenosis and Wall Shear Stress on Platelets Function
by Paweł Bańka, Maciej Wybraniec, Tomasz Bochenek, Bartosz Gruchlik, Aleksandra Burchacka, Andrzej Swinarew and Katarzyna Mizia-Stec
J. Clin. Med. 2023, 12(19), 6301; https://doi.org/10.3390/jcm12196301 - 29 Sep 2023
Viewed by 1281
Abstract
Aortic valve stenosis (AS) is a common heart valve disease in the elderly population, and its pathogenesis remains an interesting area of research. The degeneration of the aortic valve leaflets gradually progresses to valve sclerosis. The advanced phase is marked by the presence [...] Read more.
Aortic valve stenosis (AS) is a common heart valve disease in the elderly population, and its pathogenesis remains an interesting area of research. The degeneration of the aortic valve leaflets gradually progresses to valve sclerosis. The advanced phase is marked by the presence of extracellular fibrosis and calcification. Turbulent, accelerated blood flow generated by the stenotic valve causes excessive damage to the aortic wall. Elevated shear stress due to AS leads to the degradation of high-molecular weight multimers of von Willebrand factor, which may involve bleeding in the mucosal tissues. Conversely, elevated shear stress has been associated with the release of thrombin and the activation of platelets, even in individuals with acquired von Willebrand syndrome. Moreover, turbulent blood flow in the aorta may activate the endothelium and promote platelet adhesion and activation on the aortic valve surface. Platelets release a wide range of mediators, including lysophosphatidic acid, which have pro-osteogenic effects in AS. All of these interactions result in blood coagulation, fibrinolysis, and the hemostatic process. This review summarizes the current knowledge on high shear stress-induced hemostatic disorders, the influence of AS on platelets and antiplatelet therapy. Full article
(This article belongs to the Special Issue Clinical Advancement in Aortic Valve Stenosis)
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