Aortic stenosis follow up: Difference between revisions
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(/* Recommendations for Key Issues to Evaluate and Follow-Up (DO NOT EDIT) {{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenit...) |
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| [[Aortic stenosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | |||
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==Overview== | ==Overview== | ||
Follow up is recommended for all patients with operated and unoperated [[aortic stenosis]]. | Follow up is recommended for all patients with operated and unoperated [[aortic stenosis]]. | ||
Asymptomatic patients with [[aortic stenosis]] should undergo follow up since [[aortic stenosis]] is an ongoing disease that progresses with time. In fact, asymptomatic patients should undergo follow up every 1 year, 3 years and 5 years in case of severe, moderate and mild aortic stenosis respectively.<ref name="pmid9870202">{{cite journal| author=Bonow RO, Carabello B, de Leon AC, Edmunds LH, Fedderly BJ, Freed MD et al.| title=ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease). | journal=J Heart Valve Dis | year= 1998 | volume= 7 | issue= 6 | pages= 672-707 | pmid=9870202 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9870202 }} </ref> | Asymptomatic patients with [[aortic stenosis]] should undergo follow up since [[aortic stenosis]] is an ongoing disease that progresses with time. In fact, asymptomatic patients should undergo follow up every 1 year, 3 years and 5 years in case of severe, moderate and mild aortic stenosis respectively.<ref name="pmid9870202">{{cite journal| author=Bonow RO, Carabello B, de Leon AC, Edmunds LH, Fedderly BJ, Freed MD et al.| title=ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease). | journal=J Heart Valve Dis | year= 1998 | volume= 7 | issue= 6 | pages= 672-707 | pmid=9870202 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9870202 }} </ref> | ||
==Follow-Up== | |||
Frequency of [[echocardiograms]] in asymptomatic patients with aortic stenosis with normal [[stroke volume]]: | |||
* Progressive (stage B) with mild severity (V<sub>max</sub> 2.0-2.9 m/s): every 3-5 years | |||
* Progressive (stage B) with moderate severity (V<sub>max</sub> 3.0-3.9 m/s): every 1-2 years | |||
* Severe (stage C) (V<sub>max</sub>>4 m/s): every 6-12 months | |||
== 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines<ref name="pmid33332150">{{cite journal| author=Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F | display-authors=etal| title=2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. | journal=Circulation | year= 2021 | volume= 143 | issue= 5 | pages= e72-e227 | pmid=33332150 | doi=10.1161/CIR.0000000000000923 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33332150 }}</ref> == | |||
The timing of periodic clinical assessment in asymptomatic patients with severe AS is dependent on comorbidities, patient-specific characteristics, and the severity of the AS (Table 4). Aortic velocity 4.0 m/s, which indicates severe AS, is associated with a rapid onset of symptoms and a 2-year event-free survival rate of only 30% to 50%. Periodic monitoring is required in patients with severe AS who are asymptomatic since the onset of symptoms is gradual and the patient may not be aware of them. The typical annual rate of advancement for moderate AS (aortic velocity 3.0-3.9 m/s) is a rise in velocity of 0.3 m/s, an increase in the mean pressure gradient of 7 mm Hg, and a decrease in valve area of 0.1 cm2. There is significant individual variation, with older individuals and patients with more severe leaflet calcification progressing more quickly. Within five years, 10% of patients with aortic sclerosis—defined as localized regions of valve calcification and leaflet thickening with an aortic velocity 2.0 m/s—progress to severe AS. Patients with BAV illness are also at risk for developing increasing valve stenosis, with AS being the most typical indication for BAV patient intervention (Section 5.1.1). | |||
==2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Diseases (DO NOT EDIT)<ref>{{Cite web | last = | first = | title = 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary | url = http://circ.ahajournals.org/content/early/2014/02/27/CIR.0000000000000029.full.pdf+html | publisher = | date = | accessdate = 4 March 2014 }}</ref>== | |||
===Diagnostic Testing - Routine Follow-Up=== | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[EHS ESC guidelines classification scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1. '''Periodic monitoring with TTE is recommended in asymptomatic patients with known valvular heart disease at intervals depending on valve lesion, severity, [[ventricular]] size, and ventricular function. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence:C]])'' <nowiki>"</nowiki> | |||
|} | |||
==2008 ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)<ref name="pmid19038677">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= e1-121 | pmid=19038677 | doi=10.1016/j.jacc.2008.10.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038677 }} </ref> == | ==2008 ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)<ref name="pmid19038677">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2008 | volume= 52 | issue= 23 | pages= e1-121 | pmid=19038677 | doi=10.1016/j.jacc.2008.10.001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038677 }} </ref> == | ||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Lifelong [[cardiology]] follow-up is recommended for all patients with [[aortic valve disease]] (AS or [[AR]] | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Lifelong [[cardiology]] follow-up is recommended for all patients with [[aortic valve disease]] (AS or [[AR]]). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Serial imaging assessment of [[aortic root]] anatomy is recommended for all patients with BAV, regardless of severity. The frequency of imaging would depend on the size of the aorta at initial assessment: if less than 40 mm, it should be reimaged approximately every 2 years; if greater than or equal to 40 mm, it should be reimaged yearly or more often as progression of root dilation warrants or whenever there is a change in clinical symptoms or findings. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Serial imaging assessment of [[aortic root]] anatomy is recommended for all patients with BAV, regardless of severity. The frequency of imaging would depend on the size of the aorta at initial assessment: if less than 40 mm, it should be reimaged approximately every 2 years; if greater than or equal to 40 mm, it should be reimaged yearly or more often as progression of root dilation warrants or whenever there is a change in clinical symptoms or findings. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | ||
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==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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[[CME Category::Cardiology]] | |||
[[Category:Disease]] | [[Category:Disease]] | ||
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[[Category:Cardiac surgery]] | [[Category:Cardiac surgery]] | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
Latest revision as of 05:08, 8 December 2022
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Resident Survival Guide |
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Aortic Stenosis Microchapters |
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Diagnosis |
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Treatment |
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Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty |
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Transcatheter Aortic Valve Replacement (TAVR) |
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Case Studies |
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Aortic stenosis follow up On the Web |
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American Roentgen Ray Society Images of Aortic stenosis follow up |
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Risk calculators and risk factors for Aortic stenosis follow up |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Overview
Follow up is recommended for all patients with operated and unoperated aortic stenosis. Asymptomatic patients with aortic stenosis should undergo follow up since aortic stenosis is an ongoing disease that progresses with time. In fact, asymptomatic patients should undergo follow up every 1 year, 3 years and 5 years in case of severe, moderate and mild aortic stenosis respectively.[1]
Follow-Up
Frequency of echocardiograms in asymptomatic patients with aortic stenosis with normal stroke volume:
- Progressive (stage B) with mild severity (Vmax 2.0-2.9 m/s): every 3-5 years
- Progressive (stage B) with moderate severity (Vmax 3.0-3.9 m/s): every 1-2 years
- Severe (stage C) (Vmax>4 m/s): every 6-12 months
2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[2]
The timing of periodic clinical assessment in asymptomatic patients with severe AS is dependent on comorbidities, patient-specific characteristics, and the severity of the AS (Table 4). Aortic velocity 4.0 m/s, which indicates severe AS, is associated with a rapid onset of symptoms and a 2-year event-free survival rate of only 30% to 50%. Periodic monitoring is required in patients with severe AS who are asymptomatic since the onset of symptoms is gradual and the patient may not be aware of them. The typical annual rate of advancement for moderate AS (aortic velocity 3.0-3.9 m/s) is a rise in velocity of 0.3 m/s, an increase in the mean pressure gradient of 7 mm Hg, and a decrease in valve area of 0.1 cm2. There is significant individual variation, with older individuals and patients with more severe leaflet calcification progressing more quickly. Within five years, 10% of patients with aortic sclerosis—defined as localized regions of valve calcification and leaflet thickening with an aortic velocity 2.0 m/s—progress to severe AS. Patients with BAV illness are also at risk for developing increasing valve stenosis, with AS being the most typical indication for BAV patient intervention (Section 5.1.1).
2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Diseases (DO NOT EDIT)[3]
Diagnostic Testing - Routine Follow-Up
| Class I |
| "1. Periodic monitoring with TTE is recommended in asymptomatic patients with known valvular heart disease at intervals depending on valve lesion, severity, ventricular size, and ventricular function. (Level of Evidence:C) " |
2008 ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease (DO NOT EDIT)[4]
Recommendations for Key Issues to Evaluate and Follow-Up (DO NOT EDIT) [4]
| Class I |
| "1. Lifelong cardiology follow-up is recommended for all patients with aortic valve disease (AS or AR). (Level of Evidence: A)" |
| "2. Serial imaging assessment of aortic root anatomy is recommended for all patients with BAV, regardless of severity. The frequency of imaging would depend on the size of the aorta at initial assessment: if less than 40 mm, it should be reimaged approximately every 2 years; if greater than or equal to 40 mm, it should be reimaged yearly or more often as progression of root dilation warrants or whenever there is a change in clinical symptoms or findings. (Level of Evidence: B)" |
| "3. Prepregnancy counseling is recommended for women with AS who are contemplating pregnancy. (Level of Evidence: B)" |
| "4. Patient referral to a pediatric cardiologist experienced in fetal echocardiography is indicated in the second trimester of pregnancy to search for cardiac defects in the fetus. (Level of Evidence: C)" |
| "5. Women with BAV and ascending aorta diameter greater than 4.5 cm should be counseled about the high risks of pregnancy. (Level of Evidence: C)" |
| "6. Patients with moderate to severe AS should be counseled against competitive athletics and strenuous isometric exercise. (Level of Evidence: B)" |
| "7. Echocardiographic screening for the presence of BAV is recommended for first-degree relatives of patients with BAV. (Level of Evidence: B)" |
References
- ↑ Bonow RO, Carabello B, de Leon AC, Edmunds LH, Fedderly BJ, Freed MD; et al. (1998). "ACC/AHA Guidelines for the Management of Patients With Valvular Heart Disease. Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease)". J Heart Valve Dis. 7 (6): 672–707. PMID 9870202.
- ↑ Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F; et al. (2021). "2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 143 (5): e72–e227. doi:10.1161/CIR.0000000000000923. PMID 33332150 Check
|pmid=value (help). - ↑ "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary". Retrieved 4 March 2014.
- ↑ 4.0 4.1 Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.