8
Aortic Stenosis
Table 10. 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
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
