Mazzone Annamaria, Esposito Augusto, Foffa Ilenia, Berti Sergio
Fondazione Toscana Gabriele Monasterio Massa, 54100 Massa, Italy.
Istituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, 54100 Massa, Italy.
J Clin Med. 2025 Aug 7;14(15):5560. doi: 10.3390/jcm14155560.
Calcific aortic stenosis (CAS) is a newly emerging pandemic in elderly individuals due to the aging of the population in the world. Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Replacement (TAVR) are the cornerstone of the management of severe aortic stenosis accompanied by one or more symptoms. Moreover, an appropriate interventional treatment of CAS, in elderly patients, is a very complex decision for heart teams, to avoid bad outcomes such as operative mortality, cardiovascular and all-cause death, hospitalization for heart failure, worsening of quality of life. In fact, CAS in the elderly is not only a focal valve disease, but a very complex clinical picture with different risk factors and etiologies, differing underlying pathophysiology, large phenotypic heterogeneity in a context of subjective biological, phenotypic and functional aging until frailty and disability. In this review, we analyzed separately and in a more integrated manner, the natural and prognostic histories of the progression of aortic stenosis, the phenotypes of myocardial damage and heart failure, within the metrics and aging trajectory. The aim is to suggest, during the clinical timing of valve disease, the best interval time for an appropriate and effective interventional treatment in each older patient, beyond subjective symptoms by integration of clinical, geriatric, chemical, and advanced imaging biomarkers.
由于全球人口老龄化，钙化性主动脉瓣狭窄（CAS）在老年人中已成为一种新出现的流行病。外科主动脉瓣置换术（SAVR）和经导管主动脉瓣置换术（TAVR）是伴有一种或多种症状的重度主动脉瓣狭窄治疗的基石。此外，对于老年患者，对CAS进行适当的介入治疗，对于心脏团队来说是一个非常复杂的决策，以避免出现手术死亡率、心血管和全因死亡、因心力衰竭住院、生活质量恶化等不良后果。事实上，老年人的CAS不仅是一种局限性瓣膜疾病，而是一种非常复杂的临床情况，具有不同的危险因素和病因、不同的潜在病理生理学、在主观生物学、表型和功能老化直至衰弱和残疾的背景下存在较大的表型异质性。在本综述中，我们分别并以更综合的方式分析了主动脉瓣狭窄进展的自然史和预后史、心肌损伤和心力衰竭的表型，纳入了指标和老化轨迹。目的是在瓣膜疾病的临床时机，通过整合临床、老年医学、化学和先进成像生物标志物，为每位老年患者建议在超越主观症状的情况下进行适当有效介入治疗的最佳间隔时间。
