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Calcific Aortic Valve Stenosis: A Focal Disease in Older and Complex Patients-What Could Be the Best Time for an

Annamaria Mazzone1, Augusto Esposito1, Ilenia Foffa1,2

  • 1Fondazione Toscana Gabriele Monasterio Massa, 54100 Massa, Italy.

Journal of Clinical Medicine
|August 14, 2025
PubMed

Insights

Calcific aortic stenosis (CAS) management in the elderly is complex. This review integrates aging factors and biomarkers to determine optimal timing for interventions like aortic valve replacement (AVR).

Area of Science:

  • Cardiology
  • Geriatrics
  • Biomarker Research

Background:

  • Calcific aortic stenosis (CAS) is a growing concern in aging populations worldwide.
  • Decisions regarding aortic valve replacement (SAVR, TAVR) for severe CAS in elderly patients are complex, balancing risks and benefits.
  • CAS in older adults involves multifaceted factors beyond valve disease, including aging, frailty, and comorbidities.

Purpose of the Study:

  • To analyze the natural history and progression of aortic stenosis in the elderly.
  • To explore phenotypes of myocardial damage and heart failure in aging patients with CAS.
  • To propose optimal timing for interventional treatment of CAS in older individuals using integrated biomarkers.

Main Methods:

  • Review of natural and prognostic histories of aortic stenosis progression.
  • Analysis of myocardial damage and heart failure phenotypes in aging.
  • Integration of clinical, geriatric, chemical, and advanced imaging biomarkers.

Main Results:

  • CAS in the elderly presents significant phenotypic heterogeneity and complex aging trajectories.
  • Subjective symptoms alone are insufficient for determining optimal intervention timing.
  • A comprehensive biomarker approach is crucial for personalized treatment decisions.

Conclusions:

  • Optimal interventional timing for CAS in elderly patients requires integrating multiple data sources.
  • Biomarker-driven strategies can improve outcomes beyond symptom-based assessments.
  • Personalized management is key to avoiding adverse events and improving quality of life in older adults with CAS.

Keywords:
appropriate interventional treatmentbiomarkersmanagement of severe aortic stenosisolder patient

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