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Evaluating Medical Therapy for Calcific Aortic Stenosis: JACC State-of-the-Art Review


Lindman BRBrian R , Sukul DDevraj , Dweck MRMarc R , Madhavan MVMahesh V , Arsenault BJBenoit J , Coylewright MMegan , Merryman WDW David , Newby DEDavid E , Lewis JJohn , Harrell FEFrank E , Mack MJMichael J , Leon MBMartin B , Otto CMCatherine M , Pibarot PPhilippe . Journal of the American College of Cardiology. 2021 12 7; 78(23). 2354-2376


Despite numerous promising therapeutic targets, there are no proven medical treatments for calcific aortic stenosis (AS). Multiple stakeholders need to come together and several scientific, operational, and trial design challenges must be addressed to capitalize on the recent and emerging mechanistic insights into this prevalent heart valve disease. This review briefly discusses the pathobiology and most promising pharmacologic targets, screening, diagnosis and progression of AS, identification of subgroups that should be targeted in clinical trials, and the need to elicit the patient voice earlier rather than later in clinical trial design and implementation. Potential trial end points and tools for assessment and approaches to implementation and design of clinical trials are reviewed. The efficiencies and advantages offered by a clinical trial network and platform trial approach are highlighted. The objective is to provide practical guidance that will facilitate a series of trials to identify effective medical therapies for AS resulting in expansion of therapeutic options to complement mechanical solutions for late-stage disease.