Asymptomatic severe aortic stenosis: Biomarkers are welcome

Abstract

Calcified aortic stenosis (AS) is the most common form of valvular heart disease in the developed world. Severe AS has >7% prevalence among those older than 80 years.1 Current guidelines recommend aortic valve intervention with a class I indication for patients with symptomatic severe AS. Indications have been expanded for asymptomatic patients with severe AS to include those with a left ventricular ejection fraction (LVEF) of <50%, a positive exercise stress test, decreased blood pressure on stress testing or critical AS (specifically peak aortic jet velocity (Vmax) ≥5 m/s). However, the management of patients with asymptomatic severe AS who are not covered by these recommendations still represents a clinical conundrum. A close surveillance (‘watchful waiting’) strategy is usually adopted in this situation, and decisions are made on an individual basis. Some patients with asymptomatic severe AS and normal LVEF are inevitably more vulnerable to future adverse events than others; therefore, the identification of potential biomarkers that might be helpful in the risk stratification of these patients is of particular importance.