Monitoring a narrowed, stiff aortic valve

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As some people age, the valve leading to the heart's largest vessel (aorta) can become clogged with calcium deposits, causing the valve to stiffen and narrow. A study in the Oct. 3, 2018, JAMA Cardiology looked at strategies for treating the condition, known as aortic stenosis.

Aortic stenosis — which generally causes no symptoms for many years — is usually detected during a routine check-up. Doctors usually recommend replacing the aortic valve soon after symptoms such as chest pain, shortness of breath, or fainting occur, as these can foretell sudden cardiac death. However, the best strategy for people who have severe aortic stenosis but no symptoms is less clear.

The study involved 1,375 people with moderate to severe aortic stenosis without symptoms who were followed in heart valve clinics over a 13-year period. At two, four, and eight years, respectively, 93%, 86%, and 75% of those who did not have a valve replacement were still alive, confirming that a "watchful waiting" approach appears safe.

With severe stenosis, certain heart function tests may help predict survival. If confirmed, the results may help doctors to determine better if and when to replace aortic valves.