Implementation of diagnosis in asymptomatic patients with aortic stenosis

Frequently in clinical practice, some physicians refer patients with aortic stenosis for an invasive approach in the asymptomatic phase of the disease. This empirical behaviour, which is in contrast with the recommendations of the current international clinical guidelines, is due to the perception that the prognosis of these patients is truly worse than retained. Actually, the management of asymptomatic patients with aortic stenosis remains controversial, and there is no clear agreement on how to reduce excess clinical events associated with the presence of aortic stenosis mortality and morbidity demonstrated in these patients by recent randomized clinical trials. The prevailing attention of the attending physicians is often limited to the assessment of the aortic stenosis severity and appearance of symptoms, but it has been clearly shown, instead, that the prognosis of these patients is associated with excessive left-ventricular mass growth and increased atherosclerosis leading to coronary artery disease, heart failure, stroke and death. Thus, apart from the markers of faster aortic stenosis progression, many other clinical and echocardiographic variables should be considered, collected and used together with the clinical/echocardiographic prognostic scores recently validated by several authors in clinical practice, where the vast majority of these variables are guiltily not taken into any consideration. The registry on the Implementation of Diagnosis in asymptomatic patiEnts with Aortic Stenosis is a prospective study designed with the aim to improve the diagnostic evaluation and improve the prognostic stratification of patients with asymptomatic aortic stenosis.