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
