Management of Asymptomatic Severe Aortic Stenosis: Current Evidence and Future Directions.

Systematic Severe aortic stenosis (AS) is a progressive disease and one of the most common valvular heart diseases in developed countries. The management of asymptomatic severe AS remains challenging and requires a tailored, patient-specific approach. Optimal timing of intervention in asymptomatic patients continues to be a matter of ongoing debate. In individuals with severe AS and reduced left ventricular ejection fraction (LVEF), both the ESC/EACTS and ACC/AHA guidelines recommend aortic valve replacement (AVR), regardless of symptom status. In contrast, for patients with preserved LVEF (≥50%), the decision to proceed with AVR must be individualized and based on a comprehensive risk assessment. Risk stratification plays a central role in guiding early intervention strategies and should incorporate clinical findings, echocardiographic parameters, biomarkers, and advanced imaging techniques such as cardiac magnetic resonance and computed tomography. Recent randomized controlled trials have yielded mixed results regarding the mortality benefit of early AVR but have consistently demonstrated a reduction in heart failure-related hospitalizations. Timely intervention in carefully selected high-risk patients may improve long-term outcomes, while avoiding unnecessary procedures in lower-risk individuals remains equally important.