Aortic stenosis: new pathophysiological mechanisms and their therapeutic implications

Aortic stenosis (AS) represents the most common type of acquired valvular heart disease. Its incidence increases with age; therefore, from 3% to 9% of adults over 75 years of age develop AS. The pathophysiological mechanisms and role of biomarkers in the prediction of AS have been extensively studied. Progression of AS is characterized by a number of abnormalities in calcification regulation, inflammation/adipokine dysregulation, prothrombic state, and altered von Willebrand factor function. The current understanding of the mechanisms of AS involves a complex role of the multiple cell types, in particular myofibroblasts and macrophages. The introduction of transcatheter aortic valve implantation provides invaluable opportunities for periprocedural and long-term monitoring of the changes in the biomarker profile. Effective pharmacological treatment, especially in the early stage of AS, is largely unknown. The current review discusses not only the pathophysiology of AS but also attempts at pharmacological treatment.