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2016 ; 2
(ä): 16006
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Calcific aortic stenosis
#MMPMID27188578
Lindman BR
; Clavel MA
; Mathieu P
; Iung B
; Lancellotti P
; Otto CM
; Pibarot P
Nat Rev Dis Primers
2016[Mar]; 2
(ä): 16006
PMID27188578
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Calcific aortic stenosis (AS) is the most prevalent heart valve disorder in
developed countries. It is characterized by progressive fibro-calcific
remodelling and thickening of the aortic valve leaflets that, over years, evolve
to cause severe obstruction to cardiac outflow. In developed countries, AS is the
third-most frequent cardiovascular disease after coronary artery disease and
systemic arterial hypertension, with a prevalence of 0.4% in the general
population and 1.7% in the population >65 years old. Congenital abnormality
(bicuspid valve) and older age are powerful risk factors for calcific AS.
Metabolic syndrome and an elevated plasma level of lipoprotein(a) have also been
associated with increased risk of calcific AS. The pathobiology of calcific AS is
complex and involves genetic factors, lipoprotein deposition and oxidation,
chronic inflammation, osteoblastic transition of cardiac valve interstitial cells
and active leaflet calcification. Although no pharmacotherapy has proved to be
effective in reducing the progression of AS, promising therapeutic targets
include lipoprotein(a), the renin-angiotensin system, receptor activator of NF-?B
ligand (RANKL; also known as TNFSF11) and ectonucleotidases. Currently, aortic
valve replacement (AVR) remains the only effective treatment for severe AS. The
diagnosis and staging of AS are based on the assessment of stenosis severity and
left ventricular systolic function by Doppler echocardiography, and the presence
of symptoms. The introduction of transcatheter AVR in the past decade has been a
transformative therapeutic innovation for patients at high or prohibitive risk
for surgical valve replacement, and this new technology might extend to
lower-risk patients in the near future.
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