Beta-blockers can improve survival in medically-treated patients with severe symptomatic aortic stenosis

In patients with symptomatic severe aortic stenosis (AS), surgical or percutaneous aortic valve replacement (AVR) is the only treatment with proven ability to improve survival [1]. Nonetheless, a consistent proportionof symptomatic patients with severe AS remain un-operated [2]. This patient group has an extremely unfavorable prognosis with no available medical therapy of proven efficacy. Although the majority ofthese patients are also affected by heart failure, the recommended drugs able to counteract the negative effects of heart failure are generally precluded due to the fear that they could worsen flow obstruction atthe valve level. In particular, AS is traditionally considered a contraindication for beta-blockers (BBs) although, in asymptomatic patients with AS, BB use has been associatedwith improved survival [3]. We aimed toassess whether BBs could have a protective effect also on patients with symptomatic medically treated AS.