The Role of Extra-valvular Cardiac Damage Staging in Aortic Valve Disease Management.

ABSTRACT Current management of patients with aortic valve disease including aortic valve stenosis (AS), aortic valve regurgitation (AR) and mixed aortic valve disease (MAVD) remains challenging. American and European guideline recommendations regarding the timing of intervention are mainly based on the assessment of disease severity (i.e. grading), presence of symptoms related to aortic valve disease, left ventricular (LV) systolic dysfunction and/or LV enlargement. Furthermore, the decision regarding the type of intervention (i.e. surgical versus transcatheter) is primarily based on risk assessment from surgical risk scores. There is, however, less emphasis on the importance of the assessment of anatomical and functional cardiac repercussions of aortic valve disease to guide the clinical management of these patients. Recently, a novel approach has been proposed to improve the management of aortic valve disease with two main components for risk stratification of the disease: i) Grading the severity of aortic valve disease and ii) Staging the extent of extra-valvular cardiac damage associated with aortic valve disease using echocardiography. To date, this novel approach of extra-valvular cardiac damage staging was proposed and validated only in the context of AS but could be extended to other valvular heart diseases including AR and MAVD. Further studies are also needed to test the incremental value of additional imaging parameters (e.g. myocardial fibrosis by magnetic resonance) as well as blood biomarkers (e.g. natriuretic peptide, cardiac troponin and other) to the existing cardiac damage staging schemes.