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2017 Update Incorporated - Valvular Heart Disease

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8 Aortic Stenosis Table 8. Evaluation and Treatment in Patients With AS Recommendations COR LOE Diagnostic Testing TTE is indicated in patients with signs or symptoms of AS or a bicuspid aortic valve for accurate diagnosis of the cause of AS, hemodynamic severity, LV size and systolic function, and for determining prognosis and timing of valve intervention. I B Low-dose dobutamine stress testing using echocardiographic or invasive hemodynamic measurements is reasonable in patients with stage D2 AS with all of the following : • Calcified aortic valve with reduced systolic opening ; • LVEF <50%; • Calculated valve area ≤1.0 cm 2 ; and • Aortic velocity <4.0 m/s or ∆Pmean <40 mm Hg. I B Exercise testing is reasonable to assess physiological changes with exercise and to confirm the absence of symptoms in asymptomatic patients with a calcified aortic valve and aortic velocity ≥4.0 m/s or ∆Pmean ≥40 mm Hg (stage C). IIa B Exercise testing should NOT be performed in symptomatic patients with AS when the aortic velocity is ≥4.0 m/s or ∆Pmean is ≥40 mm Hg (stage D). III: Harm B Medical erapy Hypertension in patients at risk for developing AS (stage A) and in patients with asymptomatic AS (stages B and C) should be treated according to standard GDMT, started at a low dose and gradually titrated upward as needed with frequent clinical monitoring. I B Vasodilator therapy may be reasonable if used with invasive hemodynamic monitoring in the acute management of patients with severe decompensated AS (stage D) with New York Heart Association (NYHA) class IV HF symptoms. IIb C Statin therapy is NOT indicated for prevention of hemodynamic progression of AS in patients with mild-to- moderate calcific valve disease (stages B-D). III: No Benefit A

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