Aortic stenosis medical therapy: Difference between revisions

Jump to navigation Jump to search
No edit summary
Line 7: Line 7:
{{Aortic stenosis}}
{{Aortic stenosis}}
{{CMG}}; {{AOEIC}} {{Sara.Zand}} [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]; {{CZ}}; {{USAMA}} '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu]; {{Rim}}
{{CMG}}; {{AOEIC}} {{Sara.Zand}} [[User:Mohammed Sbeih|Mohammed A. Sbeih, M.D.]] [mailto:msbeih@wikidoc.org]; {{CZ}}; {{USAMA}} '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu]; {{Rim}}
{{SK}} AS; Aortic stenosis; AVR; Aortic valve replacement; TAVI; Transcatheter aortic valve implantation; ACEI; Angiotensin-converting enzyme inhibitor
{{SK}} AS; Aortic stenosis; AVR; Aortic valve replacement; TAVI; Transcatheter aortic valve implantation; ACEI; Angiotensin-converting enzyme inhibitor;
==Overview==
==Overview==
Medical treatment of [[hypertension]] and [[hyperlipidemia]] according to the Guidelines is considered for [[patients]] with [[AS]]. Therapy with [[ACE inhibitor]] or [[ARB]]  may reduce the [[mortality rate]] in [[patients]] with [[AS]] who underwent [[TAVI]].
Medical treatment of [[hypertension]] and [[hyperlipidemia]] according to the Guidelines is considered for [[patients]] with [[AS]]. Therapy with [[ACE inhibitor]] or [[ARB]]  may reduce the [[mortality rate]] in [[patients]] with [[AS]] who underwent [[TAVI]].
Line 59: Line 59:
<span style="font-size:85%">'''Abbreviations:'''
<span style="font-size:85%">'''Abbreviations:'''
'''[[AS]]:''' [[ Aortic stenosis]];
'''[[AS]]:''' [[ Aortic stenosis]];
'''TAVI:''' [[Transcatheter aortic valve insetion]];
'''[[TAVI]]:''' [[Transcatheter aortic valve implantation]];


</span>
</span>

Revision as of 14:18, 30 June 2022



Resident
Survival
Guide

Aortic Stenosis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Aortic Stenosis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Cardiac Stress Test

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography

Cardiac Catheterization

Aortic Valve Area

Aortic Valve Area Calculation

Treatment

General Approach

Medical Therapy

Surgery

Percutaneous Aortic Balloon Valvotomy (PABV) or Aortic Valvuloplasty

Transcatheter Aortic Valve Replacement (TAVR)

TAVR vs SAVR
Critical Pathway
Patient Selection
Imaging
Evaluation
Valve Types
TAVR Procedure
Post TAVR management
AHA/ACC Guideline Recommendations

Follow Up

Prevention

Precautions and Prophylaxis

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Aortic stenosis medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Aortic stenosis medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Aortic stenosis medical therapy

CDC on Aortic stenosis medical therapy

Aortic stenosis medical therapy in the news

Blogs on Aortic stenosis medical therapy

Directions to Hospitals Treating Aortic stenosis medical therapy

Risk calculators and risk factors for Aortic stenosis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Sara Zand, M.D.[2] Mohammed A. Sbeih, M.D. [3]; Cafer Zorkun, M.D., Ph.D. [4]; Usama Talib, BSc, MD [5] Assistant Editor-In-Chief: Kristin Feeney, B.S. [6]; Rim Halaby, M.D. [7] Synonyms and keywords: AS; Aortic stenosis; AVR; Aortic valve replacement; TAVI; Transcatheter aortic valve implantation; ACEI; Angiotensin-converting enzyme inhibitor;

Overview

Medical treatment of hypertension and hyperlipidemia according to the Guidelines is considered for patients with AS. Therapy with ACE inhibitor or ARB may reduce the mortality rate in patients with AS who underwent TAVI.

Medical Therapy

Recommendations for medical therapy in aortic stenosis
(Class I, Level of Evidence B):

❑ In patients at risk of developing AS (stage A) or asymptomatic AS (stage B,C), hypotension should be controlled by initiating low dose medications and titration doses based on clinical evaluation

(Class I, Level of Evidence A):

Statin therapy is recommended in all patients with calcified AS for primary and secondary prevention of atherosclerosis

(Class IIb, Level of Evidence B):

ACEI or ARB may be considered after TAVI to reduce the long term risk of all cause mortality

NO benefit(Class III, Level of Evidence A):

Statin is not indicated in calcified AS (stage B,C) for prevention of hemodynamic progression of AS

The above table adopted from 2020 AHA-ACC Guideline


Abbreviations: AS: Aortic stenosis; TAVI: Transcatheter aortic valve implantation;


References

  1. Nazarzadeh M, Pinho-Gomes AC, Smith Byrne K, Canoy D, Raimondi F, Ayala Solares JR, Otto CM, Rahimi K (August 2019). "Systolic Blood Pressure and Risk of Valvular Heart Disease: A Mendelian Randomization Study". JAMA Cardiol. 4 (8): 788–795. doi:10.1001/jamacardio.2019.2202. PMC 6624812 Check |pmc= value (help). PMID 31290937.
  2. Nielsen OW, Sajadieh A, Sabbah M, Greve AM, Olsen MH, Boman K, Nienaber CA, Kesäniemi YA, Pedersen TR, Willenheimer R, Wachtell K (August 2016). "Assessing Optimal Blood Pressure in Patients With Asymptomatic Aortic Valve Stenosis: The Simvastatin Ezetimibe in Aortic Stenosis Study (SEAS)". Circulation. 134 (6): 455–68. doi:10.1161/CIRCULATIONAHA.115.021213. PMID 27486164.
  3. Briand M, Dumesnil JG, Kadem L, Tongue AG, Rieu R, Garcia D, Pibarot P (July 2005). "Reduced systemic arterial compliance impacts significantly on left ventricular afterload and function in aortic stenosis: implications for diagnosis and treatment". J Am Coll Cardiol. 46 (2): 291–8. doi:10.1016/j.jacc.2004.10.081. PMID 16022957.
  4. O'Brien KD, Zhao XQ, Shavelle DM, Caulfield MT, Letterer RA, Kapadia SR, Probstfield JL, Otto CM (April 2004). "Hemodynamic effects of the angiotensin-converting enzyme inhibitor, ramipril, in patients with mild to moderate aortic stenosis and preserved left ventricular function". J Investig Med. 52 (3): 185–91. doi:10.1136/jim-52-03-33. PMID 15222408.
  5. Rossebø AB, Pedersen TR, Boman K, Brudi P, Chambers JB, Egstrup K, Gerdts E, Gohlke-Bärwolf C, Holme I, Kesäniemi YA, Malbecq W, Nienaber CA, Ray S, Skjaerpe T, Wachtell K, Willenheimer R (September 2008). "Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis". N Engl J Med. 359 (13): 1343–56. doi:10.1056/NEJMoa0804602. PMID 18765433.
  6. Chan KL, Teo K, Dumesnil JG, Ni A, Tam J (January 2010). "Effect of Lipid lowering with rosuvastatin on progression of aortic stenosis: results of the aortic stenosis progression observation: measuring effects of rosuvastatin (ASTRONOMER) trial". Circulation. 121 (2): 306–14. doi:10.1161/CIRCULATIONAHA.109.900027. PMID 20048204.
  7. Moura LM, Ramos SF, Zamorano JL, Barros IM, Azevedo LF, Rocha-Gonçalves F, Rajamannan NM (February 2007). "Rosuvastatin affecting aortic valve endothelium to slow the progression of aortic stenosis". J Am Coll Cardiol. 49 (5): 554–61. doi:10.1016/j.jacc.2006.07.072. PMC 3951859. PMID 17276178.
  8. Ochiai T, Saito S, Yamanaka F, Shishido K, Tanaka Y, Yamabe T, Shirai S, Tada N, Araki M, Naganuma T, Watanabe Y, Yamamoto M, Hayashida K (April 2018). "Renin-angiotensin system blockade therapy after transcatheter aortic valve implantation". Heart. 104 (8): 644–651. doi:10.1136/heartjnl-2017-311738. PMID 28986405.
  9. Hansson NH, Sörensen J, Harms HJ, Kim WY, Nielsen R, Tolbod LP, Frøkiær J, Bouchelouche K, Dodt KK, Sihm I, Poulsen SH, Wiggers H (October 2017). "Metoprolol Reduces Hemodynamic and Metabolic Overload in Asymptomatic Aortic Valve Stenosis Patients: A Randomized Trial". Circ Cardiovasc Imaging. 10 (10). doi:10.1161/CIRCIMAGING.117.006557. PMID 28956773.
  10. Inohara T, Manandhar P, Kosinski AS, Matsouaka RA, Kohsaka S, Mentz RJ, Thourani VH, Carroll JD, Kirtane AJ, Bavaria JE, Cohen DJ, Kiefer TL, Gaca JG, Kapadia SR, Peterson ED, Vemulapalli S (December 2018). "Association of Renin-Angiotensin Inhibitor Treatment With Mortality and Heart Failure Readmission in Patients With Transcatheter Aortic Valve Replacement". JAMA. 320 (21): 2231–2241. doi:10.1001/jama.2018.18077. PMC 6583475 Check |pmc= value (help). PMID 30512100.

Template:WH Template:WS CME Category::Cardiology