Diagnosing before the first symptoms

7 de March de 2019

The calcified aortic stenosis (AD) is the third most frequent cardiovascular disease in developed countries, after coronary heart disease and hypertension, with a prevalence of 0.4% in the general population and 1.7% in the population older than 65.

It is characterized by progressive thickening and calcification of the valves of the aortic valve that, over the years, evolves and causes a severe obstruction to the blood flow from the heart to the aorta. Usually, AD begins with a long period without presenting symptoms, and the progression of its severity has a significant individual variability.

Symptoms rarely occur until the valve opening is severely affected. The classic symptoms of AD are chest pain with exertion (angina), fainting (syncope) and fatigue with exercise (dyspnea), but the identification and / or interpretation of these clinical symptoms may be difficult in patients with other conditions. diseases such as respiratory diseases, or in the elderly population. Therefore, cardiologists use echocardiography to define the extent of calcification and the degree of valvular involvement.

After the onset of symptoms, the average survival is only 2 to 3 years with a high risk of sudden death. Thus, patients with severe symptoms of AD should undergo aortic valve replacement either surgically or by catheter.

Most severe AD are detected with the symptoms and, sometimes, the cardiac damage is so advanced that the optimal time for the intervention may have passed. The challenge is to be able to detect the disease before the appearance of the first symptoms and, thus, to apply the treatment when still no damage has occurred on other cardiac structures.

In addition, AD is a multifaceted and complex affectation that also includes disorders in the degree of distensibility of the aorta and alterations in the function and geometry of the left ventricle.

The objective of the project “Integrated characterization for calcified aortic stenosis will change treatment strategies”, coordinated by Elazer R. Edelman of MIT, and by Tamara García Camarero, Gabriela Veiga Fernández and Dr. José María de la Torre from the Marqués de Valdecilla University Hospital, is characterized in an integrated way by physiopathological parameters the aortic stenosis that most benefits from the substitution treatment, which would allow a more optimal indication of the moment of intervention, relatively independent of the symptoms. For this, we have the support of the Obra Social “la Caixa” through the first call MIT-Spain “la Caixa” Foundation Seed Fund.

Our research is based on the hypothesis that the interaction between the components that govern blood circulation -such as the left ventricle, the aortic valve and the arterial system- define with greater precision the condition of the patient with AD. In short, the goal is to anticipate the symptoms and the damage, sometimes irreversible, induced by AD and, thus, intervene at the most opportune time for each patient.