Aortic valve stenosis is the most common valvular heart disease in the Western world. It currently affects more than 7% of the population over the age of 60, with severe stenosis affecting in excess of 3% of people over the age of 75. In parallel with an aging population, the prevalence of aortic stenosis and need for surgery are expected to double over the next 20 years increasing further the burden on healthcare resources. Left untreated aortic stenosis leads to an abnormally high pressure load on the left ventricle, a pathological process that induces myocyte hypertrophy and fibrosis. Initially, the adaptive process of increased wall thickness maintains normal wall stress, contraction and cardiac output. However, ultimately this becomes maladaptive leading to ventricular stiffness, an increase in myocyte hypertrophy and myocardial fibrosis eventually causing diastolic and systolic dysfunction and increased morbidity and mortality. At present there is no effective medical therapy capable of altering this course and aortic valve intervention, usually in the form of surgical aortic valve replacement, is recommended by international guidelines in patients with severe stenosis and evidence of LV decompensation (either on the basis of symptoms or a reduced ejection fraction). Following aortic valve intervention patients demonstrate a variable degree of regression of the ventricular hypertrophy with favorable prognosis demonstrated in the cohort of patients with the highest level of regression. In this chapter we will discuss the prevalence and mechanism of left ventricular hypertrophy, fibrosis and decompensation in patients with aortic stenosis. Through case examples we will illustrate common cases of patients with hypertrophy relating to AS and analyze the most recent guidelines from the American Heart Association/American College of Cardiology (2014) and European Society of Cardiology (2012) on managing patients with aortic stenosis.
|Title of host publication
|Left Ventricular Hypertrophy (LVH)
|Subtitle of host publication
|Prevalence, Risk Factors and Treatment
|Nova Science Publishers, Inc
|Number of pages
|Published - 1 Oct 2014