Publication: Índices de estenosis aórtica : mortalidad e incidencia de eventos cardiovasculares
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2023-11-06
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Universidad Complutense de Madrid
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Abstract
La estenosis aórtica (EA) es una valvulopatía consistente en la restricción progresiva de la apertura de la válvula aórtica de tal manera que se genera una obstrucción a la salida de la sangre desde el ventrículo izquierdo a la aorta. Es una de las valvulopatías más prevalentes, junto con la insuficiencia mitral. De hecho, es la más prevalente si consideramos las que son referidas para tratamiento en Europa, y esta prevalencia está al alza dado el aumento en la esperanza de vida. En su diagnóstico la ecocardiografía es la técnica fundamental, y son los parámetros ecocardiográficos, tales como la velocidad máxima transaórtica (Vmáx), el gradiente medio transaórtico (Pm) y el área valvular aórtica (AVA) los que determinan inicialmente la severidad de la valvulopatía. No se dispone actualmente de tratamiento médico eficaz que impida la progresión de la enfermedad, por lo que el único tratamiento que mejora el pronóstico es la sustitución valvular aórtica, bien mediante técnicas quirúrgicas o percutáneas.Es conocido el limitado pronóstico de los pacientes con EA severa que desarrollan síntomas, bien sea por disnea, angina o síncope. Sin embargo, el pronóstico de los pacientes que presentan una EA de menor grado de gravedad está en entredicho. Hasta hace unos años se consideraba que estos pacientes presentaban una supervivencia similar a la de los pacientes sin EA y los problemas derivaban de las comorbilidades o de su progresión hacia una EA más severa. No obstante, recientemente se han publicado registros observacionales retrospectivos en los que los pacientes con EA moderada muestran peores tasas de supervivencia que pacientes sin EA, lo que difiere de lo previamente establecido...
Aortic stenosis (AS) is a valvular heart disease which consists of progressive restriction to aortic valve opening, resulting in left ventricular outflow obstruction during systole. It is one of the most prevalent valvular heart diseases together with mitral valve regurgitation. Moreover, it is the most prevalent valvular heart disease, taking only into account those referred to treatment. Prevalence of AS is expected to be higher in view of the longer life expectancy nowadays. Echocardiography is key to diagnose AS and echocardiographic parameters such as peak jet velocity, mean transvalvular pressure gradient and aortic valve area are the main indices in AS assessment. Unfortunately, there are no medical therapies to slow disease progression, and the only effective treatment of AS is aortic valve replacement, both by surgical and percutaneous techniques. Therefore, early identification of AS, its severity degree, and its prognostic implications is mandatory.Patients with severe AS who develop symptoms, such as dyspnea, angina or syncope, are known to have a dismal prognosis. However, the prognosis of patients with non-severe AS is not clearly established. These patients are assumed to have similar survival rates than those without AS. However, large retrospective registries have recently showed worse outcomes in patients with moderate aortic stenosis, which challenges the previous assumptions...
Aortic stenosis (AS) is a valvular heart disease which consists of progressive restriction to aortic valve opening, resulting in left ventricular outflow obstruction during systole. It is one of the most prevalent valvular heart diseases together with mitral valve regurgitation. Moreover, it is the most prevalent valvular heart disease, taking only into account those referred to treatment. Prevalence of AS is expected to be higher in view of the longer life expectancy nowadays. Echocardiography is key to diagnose AS and echocardiographic parameters such as peak jet velocity, mean transvalvular pressure gradient and aortic valve area are the main indices in AS assessment. Unfortunately, there are no medical therapies to slow disease progression, and the only effective treatment of AS is aortic valve replacement, both by surgical and percutaneous techniques. Therefore, early identification of AS, its severity degree, and its prognostic implications is mandatory.Patients with severe AS who develop symptoms, such as dyspnea, angina or syncope, are known to have a dismal prognosis. However, the prognosis of patients with non-severe AS is not clearly established. These patients are assumed to have similar survival rates than those without AS. However, large retrospective registries have recently showed worse outcomes in patients with moderate aortic stenosis, which challenges the previous assumptions...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 02-03-2023