Treatment
Table 6. 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
