European Heart Journal Advance Access originally published online on June 23, 2008
European Heart Journal 2008 29(14):1783-1790; doi:10.1093/eurheartj/ehn272
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Valvular heart disease: a perspective on the asymptomatic patient with severe valvular aortic stenosis
Griffith Center, Division of Cardiovascular Medicine, Department of Medicine, LAC+USC Medical Center, University of Southern California, 2025 Zonal Avenue, GNH 7131, Los Angeles, CA 90033, USA
Received 26 March 2008; revised 14 May 2008; accepted 29 May 2008; online publish-ahead-of-print 23 June 2008.
Corresponding author. Tel: +1 323 226 7264, Fax: +1 323 221 4428, Email: rahimtoo{at}usc.edu
Early in 2006, the European Society of Cardiology (ESC) assigned the 2006 Denolin lecturer to provide a broad perspective on the asymptomatic patient with severe calcific valvular aortic stenosis (AS) in the older patient. Subsequently, in late 2006, American College of Cardiology/American Heart Association Guidelines and in 2007 ESC Guidelines have given the Class I recommendation to ‘primary’ aortic valve replacement (AVR) for asymptomatic patients with AS only to those with left ventricular dysfunction at rest and to those who only become symptomatic on exercise testing. Indications for AVR in classes IIa and IIb were provided. However, almost all of the recommendations in classes I and II were based on level of evidence C. ‘Primary’ AVR is that which is recommended for severe AS as opposed to AVR secondary to surgery for other cardiovascular disease.
Key Words: Aortic valve replacement • Sudden death • Left ventricular dysfunction • Exercise • Elderly
DENOLIN LECTURE 2006.