The Pathophysiologic Basis and Management of Calcific Aortic Valve Stenosis: JACC State-of-the-Art Review.

Abstract

Calcific aortic valve stenosis (CAVS) is the most frequent valve disorder in adults, with a steadily increasing incidence with age. Currently, no effective treatments are available to prevent or delay disease progression. In addition to progressive calcification, there is increasing recognition of the underlying roles of oxidative stress, chronic inflammation, lipoprotein deposition, and induction of osteogenic signaling in driving progression of CAVS. Although traditional markers of CAVS progression, such as increased valve gradients and reduced areas, are currently used to guide clinical decisions regarding valve replacement, these measures may not capture progression of early, potentially modifiable disease. Hence, there is a need for more sensitive markers, such as aortic valve calcification, to monitor disease progression in CAVS. This JACC State-of-the-Art Review provides a comprehensive discussion of the pathogenesis and progression of CAVS and emphasizes the unmet need for innovative medical treatments. Additionally, it explores emerging therapeutic approaches, advanced methods for evaluating disease progression, and cutting-edge techniques to measure therapeutic efficacy.