Management of Asymptomatic Severe Aortic Stenosis: Evolving Concepts in Timing of Valve Replacement

Brian R. Lindman, Marc R. Dweck, Patrizio Lancellotti, Philippe Généreux, Luc A. Piérard, Patrick T. O'Gara, Robert O. Bonow*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

59 Scopus citations


New insights into the pathophysiology and natural history of patients with aortic stenosis, coupled with advances in diagnostic imaging and the dramatic evolution of transcatheter aortic valve replacement, are fueling intense interest in the management of asymptomatic patients with severe aortic stenosis. An intervention that is less invasive than surgery could conceivably justify pre-emptive transcatheter aortic valve replacement in subsets of patients, rather than waiting for the emergence of early symptoms to trigger valve intervention. Clinical experience has shown that symptoms can be challenging to ascertain in many sedentary, deconditioned, and/or elderly patients. Evolving data based on imaging and biomarker evidence of adverse ventricular remodeling, hypertrophy, inflammation, or fibrosis may radically transform existing clinical decision paradigms. Clinical trials currently enrolling asymptomatic patients have the potential to change practice patterns and lower the threshold for intervention.

Original languageEnglish (US)
Pages (from-to)481-493
Number of pages13
JournalJACC: Cardiovascular Imaging
Issue number2
StatePublished - Feb 2020


  • aortic stenosis
  • biomarkers
  • cardiac magnetic resonance imaging
  • echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging


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