What question did this study set out to answer?

To review the pathophysiology, diagnostic imaging advances, clinical outcomes, and evolving management strategies for left ventricular systolic dysfunction in patients with aortic stenosis.

September 15, 2022Structural HeartOpen Access

Left Ventricular Systolic Dysfunction in Aortic Stenosis: Pathophysiology, Diagnosis, Management, and Future Directions

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Why the study?

LV systolic dysfunction frequently co-exists with calcific aortic stenosis and portends worse outcomes even after AVR, raising questions regarding early detection and optimal intervention timing beyond traditional guidelines.

Design

Review

Authors

NSNikolaos SpiliasInterventional / Structural Cardiology TMTrejeeve MartynHeart Failure & Transplant KDKara DenbyCleveland Clinic

Discussion

Member takes

Implication

May support earlier TAVR consideration in moderate AS with HFrEF; leaves open confirmation in prospective trials.

Key Points

To review the pathophysiology, diagnostic imaging advances, clinical outcomes, and evolving management strategies for left ventricular systolic dysfunction in patients with aortic stenosis.
Synthesized molecular and cellular mechanisms of left ventricular transition from compensatory hypertrophy to systolic failure.
Evaluated diagnostic accuracy of novel echocardiography and cardiac magnetic resonance imaging techniques in identifying subclinical ventricular remodeling.
Reviewed prognostic outcomes after surgical and transcatheter aortic valve replacement across varying degrees of stenosis and ejection fraction.
Myocyte apoptosis and progressive myocardial fibrosis drive the transition from compensatory hypertrophy to heart failure with reduced ejection fraction.
Advanced echocardiography and cardiac magnetic resonance imaging detect early, reversible myocardial remodeling before conventional ejection fraction declines.
Moderate aortic stenosis confers adverse survival outcomes in patients with reduced ejection fraction, indicating potential benefit from expanding early transcatheter valve replacement indications.

Structured PICO

Population

Patients with degenerative calcific aortic stenosis and left ventricular systolic dysfunction

Advanced imaging and early transcatheter aortic valve replacement may play a critical role in managing patients with aortic stenosis and left ventricular systolic dysfunction before irreversible remodeling occurs.

Cite This Study

Spilias et al. (2022) studied this question.

synapsesocial.com/papers/69f690f2e405cc4465bc29f4 https://doi.org/10.1016/j.shj.2022.100089

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Left Ventricular Systolic Dysfunction in Aortic Stenosis: Pathophysiology, Diagnosis, Management, and Future Directions

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Left Ventricular Systolic Dysfunction in Aortic Stenosis: Pathophysiology, Diagnosis, Management, and Future Directions

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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