Degenerative aortic stenosis (AS) affects ~2% to 4% of patients older than 65 years of age and often coexists with left ventricular (LV) systolic dysfunction. As AS progresses to severe, mortality increases to ~50% after two years of follow-up after symptoms occur or when LV systolic dysfunction is present. Aortic valve replacement (AVR)—either surgical or transcatheter intervention is currently the treatment of choice for patients with symptomatic, severe AS, but not for moderate AS. What about the patient who has moderate AS with left ventricular dysfunction? Data from a recent retrospective, multicenter, observational study suggests that patients with moderate AS and concomitant LV systolic dysfunction are at a high risk for clinical events including all-cause death, hospitalization for heart failure and aortic valve replacement. Additional studies will help to determine if earlier AVR might improve clinical outcomes in patients. Remember, if you care for patients with AS, remember the classic triad of symptoms:
Chest pain-typically precipitated by exertion and relieved by rest
Heart failure-paroxysmal nocturnal dyspnea, orthopnea, dyspnea on exertion, and shortness of breath;
Syncope-often occurs upon exertion that you teach patients to report
Always ask about the above symptoms. These patients likely need referral to a cardiothoracic service.
van Gils, L., Clavel, M., Vollema, E. M., Hahn, R. T., Spitzer, E., Delgado, V., & … Van Mieghem, N. M. (2017). Original Investigation: Prognostic Implications of Moderate Aortic Stenosis in Patients With Left Ventricular Systolic Dysfunction. Journal Of The American College Of Cardiology, 692383-2392
See Kristine Scordo, PhD, RN, ACNP-BC, FAANP speak in 2017 at a Skin, Bones, Hearts & Private Parts conference.