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Aortic stenosis (AS) is characterised both by progressive valve narrowing and the remodelling response of the left ventricle (LV) that occurs secondary to an increased afterload. The latter is of particular importance when considering the development of patient symptoms, adverse clinical events and the need for aortic valve replacement (AVR). The hypertrophic response of the left ventricle is protective for many years, even decades, yet with time it decompensates and patients transition to heart failure. Current wisdom is that valve replacement should be performed in patients with severe stenosis just as that decompensation is starting to occur. Most commonly we use symptom development as our barometer of developing myocardial ill health, however there is increasing interest in more objective markers of LV dysfunction with which to optimise the timing of AVR.1 These include imaging markers of myocardial fibrosis and early systolic dysfunction2–4 as well as serum biomarkers such as high-sensitivity troponin and N-terminal-pro-beta natriuretic peptide (NTproBNP)).5 6
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Contributors AKB drafted the initial manuscript and created the figure. MRD provided critical input on revising the manuscript. Both authors have agreed on the final contents of this manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; externally peer reviewed.
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