Assessment of Aortic Stenosis Beyond the Aortic Valve Area

Aortic stenosis (AS) is a common and complex disease for which currently there is no intervention other than aortic valve replacement (AVR). In the current guidelines, AVR is indicated for patients with symptomatic severe AS or asymptomatic severe AS with left ventricular (LV) systolic dysfunction. Therefore, proper assessment of symptomatic status and the severity of AS, as well as LV systolic and diastolic function, is crucial in patients with AS. With the efficacy and the safety of transcatheter aortic valve replacement (TAVR) now well established, the management of AS, including the indications for AVR, might drastically change in the coming years and the definition of severe AS will continue to evolve beyond the aortic valve area and gradient. Our goal in this review is to discuss the identification of high-risk populations with AS beyond the current definitions of AS severity or symptomatic status.