Management of asymptomatic severe aortic stenosis: A systematic review and meta-Analysis of randomized controlled trials

Johnson, Nicholas, Anil, Shoomena, Craig, Neil J., Shah, Benoy N., Ring, Liam, Tsampasian, Vasiliki and Vassiliou, Vassilios S. (2025) Management of asymptomatic severe aortic stenosis: A systematic review and meta-Analysis of randomized controlled trials. Minerva Cardiology and Angiology, 73 (6). pp. 778-786. ISSN 2724-5683

Microsoft Word (OpenXML) (Manuscript_Minerva Clean) - Accepted Version Restricted to Repository staff only until 1 December 2026. Available under License Creative Commons Attribution. Request a copy

Abstract

Introduction: Whilst aortic stenosis remains the most prevalent valvular abnormality, the management of asymptomatic severe aortic stenosis remains a clinical challenge. Recently, two randomised-controlled trials (RCTs) EVOLVED (Early Intervention in Patients With Asymptomatic Severe Aortic Stenosis and Myocardial Fibrosis) and Early TAVR (Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis) have been published, alongside an extended follow-up from the AVATAR (Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis) study.  Evidence Acquisition: In response, we conducted a systematic review of PubMed, Ovid, and Cochrane databases, identifying RCTs up to October 29, 2024, that compared early intervention with conventional management.  Evidence Synthesis: Four studies met the inclusion criteria, with a combined total of 1427 patients across the trials. Meta-Analysis of the primary endpoints across these studies demonstrated a benefit with early intervention (HR=0.50, 95% CI: 0.35-0.73). However, we did not find mortality and cardiac mortality to show significant reductions (HR=0.68, 95% CI: 0.40-1.18 and HR=0.66, 95% CI: 0.33-1.29, respectively). Crucially, stroke outcomes were improved with early intervention (HR=0.60, 95% CI: 0.38-0.95), as were unplanned hospitalizations (HR=0.40, 95% CI: 0.30-0.53).  Conclusions: These findings confirm the safety of early intervention and suggest a reduction in stroke incidence, although no significant benefits were observed in overall or cardiac mortality; results which can help to guide shared decision-making with patients and prevent adverse health outcomes. (Cite this article as: Johnson N, Anil S, Craig NJ, Shah BN, Ring L, Tsampasian V, et al. Management of asymptomatic severe aortic stenosis: A systematic review and meta-Analysis of randomized controlled trials. Minerva Cardiol Angiol 2025;73:778-86. DOI: 10.23736/S2724-5683.25.06950-9)

Item Type:	Article
Uncontrolled Keywords:	aortic valve stenosis,asymptomatic diseases,fibrosis,cardiology and cardiovascular medicine ,/dk/atira/pure/subjectarea/asjc/2700/2705
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups:	Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health Faculty of Science > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health
Related URLs:	http://www.scopus.com/inward/record.url?...
Depositing User:	LivePure Connector
Date Deposited:	09 Mar 2026 11:30
Last Modified:	09 Mar 2026 11:30
URI:	https://ueaeprints.uea.ac.uk/id/eprint/102262
DOI:	10.23736/S2724-5683.25.06950-9

Actions (login required)

View Item