Aortic Valve Stenosis: Progress from Diagnosis to Treatment

Aortic stenosis (AS) is the most prevalent valvular heart disease in Western countries and it is especially associated with older age. With its progressive course, AS leads to ventricular hypertrophy, impaired diastolic and systolic function, and symptomatic deterioration. The natural history of AS is closely linked to the extent of myocardial and extracardiac damage in association with the patients comorbidities. Diagnosis relies primarily on transthoracic echocardiography, which assesses valve morphology, quantifies stenosis severity, and evaluates cardiac remodeling. However, discordant grading is frequent, necessitating advanced imaging to clarify the severity and the mechanism of the stenosis and stratify risk. Treatment is predominantly interventional, as no medical therapy is able to stop disease progression. Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are the two treatment options. Special clinical scenarios—such as cardiogenic shock or concomitant cardiac amyloidosis—pose additional diagnostic and therapeutic challenges and require individualized, multidisciplinary management. Overall, contemporary AS care increasingly integrates multimodality imaging, refined risk stratification, and tailored interventional strategies to optimize outcomes.