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Treatment of calcified coronary lesions with Palmaz-Schatz stents. An intravascular ultrasound study Characteristics of abnormal post-stent optical coherence tomography findings in hemodialysis patients Coronary Microcirculation Downstream Non-Infarct-Related Arteries in the Subacute Phase of Myocardial Infarction: Implications for Physiology-Guided Revascularization Comparative efficacy of two paclitaxel-coated balloons with different excipient coatings in patients with coronary in-stent restenosis: A pooled analysis of the Intracoronary Stenting and Angiographic Results: Optimizing Treatment of Drug Eluting Stent In-Stent Restenosis 3 and 4 trials Cardiotoxicity and Cardiac Monitoring Among Chemotherapy-Treated Breast Cancer Patients Optical coherence tomography predictors of target vessel myocardial infarction after provisional stenting in patients with coronary bifurcation disease Lesion-Specific and Vessel-Related Determinants of Fractional Flow Reserve Beyond Coronary Artery Stenosis Anatomical and Functional Computed Tomography for Diagnosing Hemodynamically Significant Coronary Artery Disease: A Meta-Analysis Updated clinical classification of pulmonary hypertension Immunotherapy of Endothelin-1 Receptor Type A for Pulmonary Arterial Hypertension

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.