In patients with severe aortic stenosis (AS), aortic valve replacement (AVR), performed percutaneously or by surgery, is truly life-changing. However, in patients with moderate or mild AS, decision-making can be vexing as the optimal treatment remains unclear. Uncertainty around the need for valve replacement in such patients is especially keen in those who have dyspnoea, chest pain, or presyncope that cannot be completely attributed to the aortic valve. Moreover, evidence suggesting that moderate AS is associated with increased morbidity and mortality12 makes the decision for AVR even more poignant.
In this issue of EuroIntervention, Eerdekens et al examine the haemodynamic and clinical outcomes of a blinded, prospective, observational cohort of 52 patients with symptomatic moderate or mild aortic stenosis and preserved left ventricular (LV) function3. They tested the hypothesis that the stress aortic valve index (SAVI), defined as the aortic/left ventricular pressure ratio during dobutamine stress, would distinguish physiological responses beyond traditional valve metrics, better identifying patients for AVR who otherwise might not be treated appropriately.
The study group underwent echocardiography and transvalvular haemodynamic testing at rest, during bicycle...
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