Health Needs of Older People
Precision medicine based intervention for patients with aortic stenosis
- Anvesha Singh
- Gerry McCann
Aortic stenosis (AS) is the commonest, age-related valvular heart disease requiring surgery in the western world, and its incidence is rising with an ageing population. Almost 3% of adults >75 years in the USA have moderate to severe AS and the rate of surgical AVR has doubled in the past decade in the USA and UK(1). Current guidelines recommend waiting for symptoms before offering aortic valve replacement (AVR), the only available treatment of proven benefit. However, adverse cardiac remodelling occurs at the asymptomatic stage, with some being irreversible, and remaining a poor prognostic marker, even after AVR(2). There is therefore a need to better understand the pathophysiological pathways leading to cardiac remodelling and symptoms in AS, in order to identify therapeutic targets, to potentially halt or slow down fibrosis. Decisions on intervening in older groups are often finely balanced, even when based on high quality evidence, and greatly depends on patients’ attitudes to risk and perceived benefits. The most appropriate timing and choice of treatment for patients with asymptomatic AS is an unmet need in cardiovascular research. Identifying the characteristics of patients most likely to benefit from early surgery will greatly inform patient decisions, and facilitate personalised care.
The University of Leicester/UHL Trust is internationally renowned for clinical research and hosts a BRC, ARC, a BHF accelerator centre and multiple PhD programmes. The novel cardiac imaging techniques available in Leicester allow comprehensive non-invasive phenotyping of the remodelling progression and regression, serving as a trial platform for testing efficacy of novel therapies. Ongoing RCT cohorts will be utilised to validate novel imaging and plasma biomarkers, and identify potential therapeutic targets for the future. The ACF will join a highly successful multidisciplinary group led by NIHR Research Professor Gerry McCann (https://www2.le.ac.uk/departments/cardiovascular-sciences/people/mccann). The group benefits from state-of-the-art facilities with a dedicated 3T MRI research scanner with multinuclear and exercise capability and biomarker facility with multiple mass-spectrometers for high throughput discovery studies.
- Nkomo V, Gardin J, Skelton T, Gottdiener J, Scott C, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005-11.
- Musa TA, Treibel TA, Vassiliou VS, Captur G, Singh A, Chin C, et al. Myocardial Scar and Mortality in Severe Aortic Stenosis. Circulation. 2018;138(18):1935-47.