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Systems of Care for ST-Segment–Elevation Myocardial Infarction: A Policy Statement From the American Heart Association Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association Natural History of Spontaneous Coronary Artery Dissection With Spontaneous Angiographic Healing Precisely Tuned Inhibition of HIF Prolyl Hydroxylases Is Key for Cardioprotection After Ischemia Successful catheter ablation of electrical storm after myocardial infarction Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention Genetic dysregulation of endothelin-1 is implicated in coronary microvascular dysfunction Coronary Artery Calcium Is Associated with Left Ventricular Diastolic Function Independent of Myocardial Ischemia Invasive Coronary Physiology After Stent Implantation: Another Step Toward Precision Medicine Prevalence, Presentation and Treatment of 'Balloon Undilatable' Chronic Total Occlusions: Insights from a Multicenter US Registry

Review ArticleVolume 13, Issue 2 Part 1, February 2020

JOURNAL:JACC Cardiovasc Imaging. Article Link

Management of Asymptomatic Severe Aortic Stenosis: Evolving Concepts in Timing of Valve Replacement

BR Lindman, MR Dweck, P Lancellotti et al. Keywords: aortic stenosis; biomarkers; cardiac magnetic resonance imaging; echocardiography

ABSTRACT

New insights into the pathophysiology and natural history of patients with aortic stenosis, coupled with advances in diagnostic imaging and the dramatic evolution of transcatheter aortic valve replacement, are fueling intense interest in the management of asymptomatic patients with severe aortic stenosis. An intervention that is less invasive than surgery could conceivably justify pre-emptive transcatheter aortic valve replacement in subsets of patients, rather than waiting for the emergence of early symptoms to trigger valve intervention. Clinical experience has shown that symptoms can be challenging to ascertain in many sedentary, deconditioned, and/or elderly patients. Evolving data based on imaging and biomarker evidence of adverse ventricular remodeling, hypertrophy, inflammation, or fibrosis may radically transform existing clinical decision paradigms. Clinical trials currently enrolling asymptomatic patients have the potential to change practice patterns and lower the threshold for intervention.