Myocardial Fibrosis Predicts Outcomes in Asymptomatic Severe Aortic Stenosis, But Early Valve Replacement May Not Offer Universal Benefit

Highlights

Myocardial fibrosis burden emerges as a significant predictor of adverse outcomes in asymptomatic patients with severe aortic stenosis, including increased risk of death and unplanned hospitalizations. Early intervention with transcatheter or surgical aortic valve replacement demonstrates a notable reduction in aortic stenosis-related hospitalizations specifically among patients with high fibrosis burden above the median. However, the EVOLVED trial finds no statistically significant heterogeneity in overall treatment effects based on fibrosis degree, challenging the notion that myocardial fibrosis is the definitive marker for timing of intervention in all patients.

Background: The Clinical Challenge of Asymptomatic Aortic Stenosis