Normal Aortic Valve
Normal

 

Severe Aortic Stenosis
Severe Aortic Stenosis

Progression of Aortic Stenosis

About Aortic Stenosis

Symptoms. Progression. Diagnosing.


Aortic stenosis is a narrowing of the aortic valve opening that restricts normal blood flow to the entire body.  It is estimated to be prevalent in up to 7% of the population over the age of 65.1   It is a common public health problem affecting millions of people in the United States.3   It is also more likely to affect men than women. 80% of adults with symptomatic aortic stenosis are male.1  

After the onset of symptoms, patients with severe aortic stenosis have a survival rate as low as 50% at 2 years and 20% at 5 years without aortic valve replacement.1 

*Otto CM. Timing of aortic valve surgery. Heart. 2000;84:211-18.

Aortic stenosis is a slow, progressive disorder that starts with aortic sclerosis and progresses to aortic stenosis where there is severe calcification of the leaflets. 

 

Aortic Stenosis Incidence Rate

Minimally Diseased Aortic Valve/Severe Stenotic Aortic Valve
   




Causes of Aortic Stenosis

Causes of Aortic Stenosis

 

Major Risk Factors for Aortic Valve Disease

Factors associated with an increased risk of aortic valve disease include the following:2  

           - Increasing age
           - Hypertension
           - Smoking
           - Elevated lipoprotein A
           - Elevated LDL cholesterol

 

Healthy and Diseased Aortic Valve Comparison














Common Symptoms of Aortic Stenosis

Signs of Aortic Stenosis

           - Angina
           - Fatigue
           - Shortness of breath
           - Difficulty when exercising
           - Lightheadedness, dizziness, and fainting
           - Swollen ankles and feet
           - Rapid or irregular heartbeat
           - Palpitations - an uncomfortable awareness
             of the heart beating rapidly or irregularly

However, heart valve disease may occur with no outward symptoms.

 

Quality of life is significantly impacted in patients with symptomatic aortic stenosis
Patients with severe aortic stenosis often develop debilitating symptoms that can restrict normal day-to-day activities, such as walking short distances or climbing stairs. These patients can often benefit from surgery to replace their ailing valve, but only approximately two-thirds of them undergo the procedure each year.3  

Valve replacement is the standard of care.6   Patients today who develop severe aortic valve stenosis have multiple treatment options.

 

Severe Aortic Stenosis Mortality Rate 

Diagnosing Aortic Stenosis

Preliminary Diagnosis of Aortic Stenosis

Detection and estimation of disease severity can often be achieved by auscultation.
Look for:6  
- Audible systolic heart murmur
      - Longer duration with later peak is consistent with more severe stenosis
      - Loudness of the murmur does not necessarily correlate with the severity of stenosis
- Soft or absent second heart sound
- Delayed carotid upstroke

Multiple modalities may be used to diagnose severe aortic stenosis

Aortic Stenosis Diagnostic Methods Yo

An Overview of the 2014 AHA/ACC Valvular Heart Disease Guidelines - Symptomatic Severe Aortic Stenosis

 

Aortic Stenosis Grading Severity

 



Aortic Stenosis: Survival After Onset

Patients may live with aortic stenosis for many years during a latent asymptomatic period that precedes the point that symptoms of the disease develop.  However, after patients begin experiencing symptoms, prompt treatment becomes necessary.

Patient survival after onset and latent period1  
Once symptoms appear, untreated patients have a poor prognosis.7  Without treatment, symptomatic aortic stenosis will eventually lead to death.

 Aortic Stenosis Patient Survival

 

Cohort B - The PARTNER Trial

Standard Therapies Are Inadequate for Severe Aortic Stenosis

Cohort B - The PARTNER Trial

Standard Therapies Are Inadequate for Aortic Stenosis
 

       - In inoperable patients with severe aortic stenosis who did not receive a valve replacement, 50% died
         within one year.
       - Despite the frequent utilization of BAV, standard therapy did not do much to alter the dismal course of
         disease for inoperable patients with severe aortic stenosis.


Aortic Stenosis: Under-treatment

The only effective treatment for severe aortic stenosis is aortic valve replacement.6  
If a patient is showing symptoms, treatment is crucial.  There are no medications to reverse or slow the progression of aortic stenosis.

Aortic Valve replacement is the only effective treatment considered a Class I recommendation by the American College of Cardiology and the American Heart Association.6   Patients today who develop severe aortic stenosis have multiple treatment options.

 

A Serious Unmet Need 8-14  

Under-treatment of Aortic Stenosis Patients

Another Treatment Option Now Available

Due to the dismal nature of the disease, diagnosis and treatment are crucial. Patients today with severe aortic valve stenosis have multiple treatment options. For high-risk patients and those who are not suitable for surgical aortic valve replacement, another option is now available - transcatheter aortic valve replacement (TAVR). TAVR is a less invasive procedure that does not require open heart surgery and results in lengthening patient's lives.