TAVI in moderate aortic stenosis: the earlier the better?

The negative prognostic impact of severe aortic stenosis (AS) is unquestioned, and surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are well-established, guideline-recommended treatment options for patients with severe, symptomatic AS. In recent years, data have been accumulating which suggest that even moderate AS can have an adverse impact on the clinical outcomes of affected patients, thereby raising the question as to whether treatment indications should be expanded at some point.

The first question that needs to be answered when interpreting the available data on moderate AS is whether moderate AS really is an independent predictor of outcome, or if it is just a surrogate parameter for other prognostically relevant comorbidities. Several studies attempting to answer this question demonstrated a negative prognostic impact of moderate AS on cardiovascular outcomes, independent of any confounding factors1. This was particularly pronounced in patients suffering from symptoms and in those with reduced left ventricular ejection fraction (LVEF). A recently published propensity score-matched analysis by Jean et al comparing the clinical outcomes of patients with heart failure (HF) alone versus HF...