Aortic stenosis in adults: systematic review of epidemiology, pathophysiology, diagnosis and management – 2025 update

Abstract

Aortic stenosis is the most common acquired valvular heart disease in adults and a major cause of cardiovascular morbidity and mortality, particularly in individuals over 65 years of age. It is characterized by progressive narrowing of the aortic valve orifice, usually secondary to degenerative calcification, leading to left ventricular pressure overload, concentric hypertrophy, and increased risk of heart failure, arrhythmias and sudden cardiac death. This systematic review aimed to synthesize recent evidence on the epidemiology, pathophysiology, diagnosis and management of aortic stenosis, focusing on studies published between 2018 and 2025. Searches were conducted in PubMed/MEDLINE, Embase, Cochrane Library and Scopus, including randomized clinical trials, cohort studies, meta-analyses and international guidelines. Of 3,418 studies initially identified, 162 met the inclusion criteria. Findings indicate that global prevalence continues to rise, driven by population aging, and that transcatheter aortic valve implantation (TAVI) has expanded significantly. Recent guidelines reinforce the central role of echocardiography in diagnosis, while emerging imaging markers and hemodynamic models provide improved risk stratification. We conclude that therapeutic advances have significantly modified the prognosis of aortic stenosis, especially in older adults and high-risk surgical patients, although challenges remain regarding optimal timing and management of low-flow aortic stenosis.