The Staging of Cardiac Damage for Aortic Stenosis: A Review

Abstract

The advent and success of transcatheter aortic valve replacement (TAVR) for the treatment of severe, symptomatic aortic stenosis (AS) has sparked a renewed interest in the disease process associated with the valve disorder. While it is evident that untreated AS is fatal, the progressive and cumulative effects of AS on the heart have only recently been studied in a widespread fashion, after the initial pivotal TAVR trials in the United States. From these data, a novel staging system has been developed to characterize the extent of cardiac damage caused by AS. This staging system facilitates risk stratification of patients with AS using echocardiographic data and measurements to derive an assessment of morbidity and mortality. After being successfully validated using outcomes from several TAVR trials, the model has now been extrapolated to patients with moderate AS and other cardiac valve disorders as well. In this review, we explore the origins of the cardiac damage staging system, its validation, and uses in various cardiac conditions.