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<p>Asymptomatic severe aortic stenosis (AS) has long been managed using a&#xa0;conservative watchful waiting strategy until the onset of classical symptoms; however, recent pathophysiological insights and randomized trials increasingly challenge this paradigm. Even during the asymptomatic stage, chronic left ventricular pressure overload promotes maladaptive remodelling with interstitial fibrosis, diastolic dysfunction and subclinical myocardial injury. Contemporary risk stratification tools including global longitudinal strain analysis, cardiac magnetic resonance imaging (MRI) and biomarker assessment enable earlier identification of patients at increased risk for decompensation and irreversible myocardial damage. Randomized trials such as RECOVERY, AVATAR and EARLY-TAVR demonstrated benefits of early intervention regarding cardiovascular events and unplanned hospitalization. In particular, the development of transfemoral transcatheter aortic valve implantation (TAVI) with low procedural risk has fundamentally changed the discussion regarding the optimal timing of interventions. Therapeutic decisions should be individualized within an interdisciplinary heart team integrating clinical, echocardiographic and myocardial parameters.</p>

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Asymptomatische hochgradige Aortenstenose

  • 期刊论文

  • 发表日期：

    2026年7月20日

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  • Sébastien Elvinger,
  • Philip Raake

摘要

Asymptomatic severe aortic stenosis (AS) has long been managed using a conservative watchful waiting strategy until the onset of classical symptoms; however, recent pathophysiological insights and randomized trials increasingly challenge this paradigm. Even during the asymptomatic stage, chronic left ventricular pressure overload promotes maladaptive remodelling with interstitial fibrosis, diastolic dysfunction and subclinical myocardial injury. Contemporary risk stratification tools including global longitudinal strain analysis, cardiac magnetic resonance imaging (MRI) and biomarker assessment enable earlier identification of patients at increased risk for decompensation and irreversible myocardial damage. Randomized trials such as RECOVERY, AVATAR and EARLY-TAVR demonstrated benefits of early intervention regarding cardiovascular events and unplanned hospitalization. In particular, the development of transfemoral transcatheter aortic valve implantation (TAVI) with low procedural risk has fundamentally changed the discussion regarding the optimal timing of interventions. Therapeutic decisions should be individualized within an interdisciplinary heart team integrating clinical, echocardiographic and myocardial parameters.