Staging classification for cardiac damage associated with aortic stenosis

This editorial refers to ‘Refined staging classification of cardiac damage associated with aortic stenosis and outcomes after transcatheter aortic valve implantation’, by T. Okuno et al. on 10.1093/ehjqcco/qcab041. The natural history of untreated severe aortic stenosis is well described1 with symptoms and the risk of death increasing over time. Both conventional aortic valve replacement (AVR) and transcatheter aortic valve implantation (TAVI) reduce symptoms, improve exercise tolerance, and improve prognosis.2 The key indications for intervention in the European Society of Cardiology guidelines3 are symptoms and/or deteriorating left ventricular function. Critical aortic stenosis, rapidly progressive aortic stenosis, and an abnormal blood pressure response to exercise are relative indications for intervention in patients with asymptomatic severe aortic stenosis with preserved left ventricular function. TAVI was first undertaken almost 20 years ago and AVR over 60 years ago; both are now routinely and widely performed. With the development of more...