Evolving perspectives on aortic stenosis: the increasing importance of evaluating the right ventricle before aortic valve intervention
Aortic stenosis (AS) was historically considered a disease of the left side of the heart, with the main pathophysiological impact being predominantly on the left ventricle (LV). However, progressive pressure overload in AS can initiate a cascade of extra-valvular myocardial remodeling that could als...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1506993/full |
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| author | Vitaliy Androshchuk Omar Chehab Joshua Wilcox Benedict McDonaugh Natalie Montarello Ronak Rajani Bernard Prendergast Tiffany Patterson Simon Redwood |
| author_facet | Vitaliy Androshchuk Omar Chehab Joshua Wilcox Benedict McDonaugh Natalie Montarello Ronak Rajani Bernard Prendergast Tiffany Patterson Simon Redwood |
| author_sort | Vitaliy Androshchuk |
| collection | DOAJ |
| description | Aortic stenosis (AS) was historically considered a disease of the left side of the heart, with the main pathophysiological impact being predominantly on the left ventricle (LV). However, progressive pressure overload in AS can initiate a cascade of extra-valvular myocardial remodeling that could also precipitate maladaptive alterations in the structure and function of the right ventricle (RV). The haemodynamic and clinical importance of these changes in patients with AS have been largely underappreciated in the past. Contemporary data indicates that RV dilatation or impairment identifies the AS patients who are at increased risk of adverse clinical outcomes after aortic valve replacement (AVR). It is now increasingly recognised that effective quantitative assessment of the RV plays a key role in delineating the late clinical stage of AS, which could improve patient risk stratification. Despite the increasing emphasis on the pathological significance of RV changes in AS, it remains to be established if earlier detection of these changes can improve the timing for intervention. This review will summarise the features of normal RV physiology and the mechanisms responsible for RV impairment in AS. In addition, we will discuss the multimodality approach to the comprehensive assessment of RV size, function and mechanics in AS patients. Finally, we will review the emerging evidence reinforcing the negative impact of RV dysfunction on clinical outcomes in AS patients treated with AVR. |
| format | Article |
| id | doaj-art-027f046630bb456bbc6eadb1b1d6402d |
| institution | Kabale University |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-027f046630bb456bbc6eadb1b1d6402d2025-01-08T06:11:36ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-01-011110.3389/fcvm.2024.15069931506993Evolving perspectives on aortic stenosis: the increasing importance of evaluating the right ventricle before aortic valve interventionVitaliy Androshchuk0Omar Chehab1Joshua Wilcox2Benedict McDonaugh3Natalie Montarello4Ronak Rajani5Bernard Prendergast6Tiffany Patterson7Simon Redwood8School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United KingdomSchool of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United KingdomCardiovascular Directorate, St Thomas’ Hospital, London, United KingdomCardiovascular Directorate, St Thomas’ Hospital, London, United KingdomCardiovascular Directorate, St Thomas’ Hospital, London, United KingdomSchool of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United KingdomHeart, Vascular & Thoracic Institute, Cleveland Clinic London, London, United KingdomCardiovascular Directorate, St Thomas’ Hospital, London, United KingdomSchool of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United KingdomAortic stenosis (AS) was historically considered a disease of the left side of the heart, with the main pathophysiological impact being predominantly on the left ventricle (LV). However, progressive pressure overload in AS can initiate a cascade of extra-valvular myocardial remodeling that could also precipitate maladaptive alterations in the structure and function of the right ventricle (RV). The haemodynamic and clinical importance of these changes in patients with AS have been largely underappreciated in the past. Contemporary data indicates that RV dilatation or impairment identifies the AS patients who are at increased risk of adverse clinical outcomes after aortic valve replacement (AVR). It is now increasingly recognised that effective quantitative assessment of the RV plays a key role in delineating the late clinical stage of AS, which could improve patient risk stratification. Despite the increasing emphasis on the pathological significance of RV changes in AS, it remains to be established if earlier detection of these changes can improve the timing for intervention. This review will summarise the features of normal RV physiology and the mechanisms responsible for RV impairment in AS. In addition, we will discuss the multimodality approach to the comprehensive assessment of RV size, function and mechanics in AS patients. Finally, we will review the emerging evidence reinforcing the negative impact of RV dysfunction on clinical outcomes in AS patients treated with AVR.https://www.frontiersin.org/articles/10.3389/fcvm.2024.1506993/fullright ventriclepulmonary hypertensioncardiovascular riskaortic stenosisaortic valve replacement |
| spellingShingle | Vitaliy Androshchuk Omar Chehab Joshua Wilcox Benedict McDonaugh Natalie Montarello Ronak Rajani Bernard Prendergast Tiffany Patterson Simon Redwood Evolving perspectives on aortic stenosis: the increasing importance of evaluating the right ventricle before aortic valve intervention Frontiers in Cardiovascular Medicine right ventricle pulmonary hypertension cardiovascular risk aortic stenosis aortic valve replacement |
| title | Evolving perspectives on aortic stenosis: the increasing importance of evaluating the right ventricle before aortic valve intervention |
| title_full | Evolving perspectives on aortic stenosis: the increasing importance of evaluating the right ventricle before aortic valve intervention |
| title_fullStr | Evolving perspectives on aortic stenosis: the increasing importance of evaluating the right ventricle before aortic valve intervention |
| title_full_unstemmed | Evolving perspectives on aortic stenosis: the increasing importance of evaluating the right ventricle before aortic valve intervention |
| title_short | Evolving perspectives on aortic stenosis: the increasing importance of evaluating the right ventricle before aortic valve intervention |
| title_sort | evolving perspectives on aortic stenosis the increasing importance of evaluating the right ventricle before aortic valve intervention |
| topic | right ventricle pulmonary hypertension cardiovascular risk aortic stenosis aortic valve replacement |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1506993/full |
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