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(Circulation. 2007;115:2799-2800.)
© 2007 American Heart Association, Inc.

Editorial

Aortic Stenosis

Two Steps Forward, One Step Back

Blase A. Carabello, MD

From the Department of Medicine, The W.A. "Tex" and Deborah Moncrief, Jr Chair, Baylor College of Medicine, Medical Care Line Executive, and Veterans Affairs Medical Center, Houston, Tex.

Correspondence to Blase A. Carabello, MD, Michael E. DeBakey VAMC, 2002 Holcombe Blvd, Houston, TX 77030.

Key Words: Editorials • aorta • stenosis • valves • ventricular ejection fraction

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Severe symptomatic aortic stenosis (AS) is a lethal disease, the only effective therapy for which is mechanical relief of the obstruction to outflow, ie, aortic valve replacement (AVR). Generally held tenets about AS include the following. (1) Patients with preserved systolic function have an excellent outcome after AVR.¹ (2) Patients with reduced ejection fraction (EF) and high afterload also have an excellent response to AVR because AVR reduces afterload and allows ejection performance to return toward normal.^2,3 (3) Patients with low flow, reduced EF, and pseudo-AS would not benefit from AVR. Pseudo-AS has been defined as a condition in which calculated aortic valve area falsely overestimates the severity of AS when aortic valve area is calculated at low flow.^4,5 Because in such cases the AS is in fact not severe, it has been reasoned that AVR would not be of benefit. (4) Patients with truly severe AS, low EF, and low gradient benefit from AVR when such patients demonstrate inotropic reserve.⁶ (5) Even some low-EF, low-gradient patients without inotropic reserve benefit from AVR.⁷ However, 2 studies of AS published in this issue of Circulation raise many interesting questions about our management of patients with AS.^8,9 These studies help to confirm some of our concepts of managing this disease while raising questions about others.

Articles pp 2848 and 2856

The study by Hachicha et al⁸ seems to confirm at least 1 of the aforementioned concepts: that AS patients with only mild left ventricular (LV) systolic dysfunction have an excellent outcome after . . . [Full Text of this Article]

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