Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Oct:288:28-40.
doi: 10.1016/j.ahj.2025.04.012. Epub 2025 Apr 15.

Management of asymptomatic severe aortic stenosis: A critical review of guidelines and clinical outcomes

Abbey J Grbac  1 , Melissa G Y Lee  2 , David Chye  3 , Jennifer Y Zhou  4 , Riley J Batchelor  1 , Maximilian L E Steinfort  5 , Sinjini Biswas  1 , Ronen Gurvitch  1 , William M Wilson  1 , Andrew J Taylor  6 , Jeffrey Lefkovits  1 , Patrick T O'Gara  7 , Michael A Borger  8 , Fabien Praz  9 , Gilbert Hl Tang  10 , Anoop N Koshy  11
Affiliations
Free article
Review

Management of asymptomatic severe aortic stenosis: A critical review of guidelines and clinical outcomes

Abbey J Grbac et al. Am Heart J. 2025 Oct.
Free article

Abstract

Background: Asymptomatic severe aortic stenosis (AS) poses a clinical challenge with variations in recommendations for management.

Objectives: We sought to compare contemporary guidelines focusing on asymptomatic AS management and present a summary of contemporary studies on early intervention in these patients.

Methods: Systematic search of electronic databases was conducted with guidelines analyzed using a comparative matrix. A pooled random-effects meta-analysis of randomized controlled trial (RCT) data comparing intervention versus clinical surveillance in asymptomatic severe AS was also performed.

Results: Four guidelines from ACC/AHA, ESC/EACTS, JCS/JSCS/JATS/JSVS, and NICE were included encompassing 108 recommendations. Consensus was found for intervention thresholds including left ventricular dysfunction and very severe AS while discrepancies existed in the utility of biomarkers, myocardial fibrosis, exercise stress testing and choice of intervention. Despite variation in study inclusion criteria, current RCTs on the management of asymptomatic AS indicated a significant reduction in rates of major adverse cardiovascular events when comparing early intervention to clinical surveillance (hazard ratio [HR] 0.52 [0.42, 0.63]), driven primarily by reductions in unplanned hospitalizations (HR 0.41 [0.32, 0.52]).

Conclusion: While there is broad consensus on classic indicators of severity such as left ventricular dysfunction as indication for intervention, guidelines diverge on other high-risk features warranting intervention. Early studies indicate the overall safety of early intervention, although further work is needed to identify whether it can reduce the risk of hard clinical endpoints. This underscores the need for further research and updated guidelines to clarify the optimal thresholds for intervention and harmonize treatment pathways for the growing number of patients with asymptomatic AS.

PubMed Disclaimer

Conflict of interest statement

Disclosures Dr Gurvitch is a physician proctor for Edwards Lifesciences. Dr Wilson is a physician proctor for Edwards Lifesciences. Dr Tang has received speaker's honoraria and served as a physician proctor, consultant, advisory board member, TAVR publications committee member, APOLLO trial screening committee member, and IMPACT MR steering committee member for Medtronic; has received speaker's honoraria and served as a physician proctor, consultant, advisory board member, and TRILUMINATE trial anatomic eligibility and publications committee member for Abbott Structural Heart; has served as an advisory board member for Boston Scientific and JenaValve, a consultant for NeoChord, Shockwave Medical, Peija Medical, and Shenqi Medical Technology, and has received speaker's honoraria from Siemens Healthineers. Dr Borger has received consulting and/or speakers’ honoraria from Edwards Lifesciences, Medtronic, Abbott, and CryoLife. The remaining authors have reported that they have no relationships relevant to the contents of this paper to disclose.

MeSH terms