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Asymptomatic Aortic Stenosis — EECC MCQ

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ModerateValvular Heart DiseaseAsymptomatic Aortic StenosisEECC

A 65-year-old man with asymptomatic severe aortic stenosis (Vmax 4.5 m/s, mean gradient 48 mmHg, AVA 0.8 cm2) and LVEF 62% is reviewed. He exercises regularly without symptoms. Per the 2025 ESC/EACTS Guidelines, intervention may be considered (Class IIa) in asymptomatic severe high-gradient AS if:

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — The procedural risk is low and the patient is anatomically suitable

Explanation lettering: B = shown as A · E = shown as B · D = shown as C · A = shown as D · C = shown as E

The 2025 ESC/EACTS VHD Guidelines provide a Class IIa recommendation for intervention in asymptomatic patients with severe high-gradient AS and preserved LVEF when procedural risk is low. This departs from the previous watchful-waiting approach, based on emerging evidence (EARLY TAVR, AVATAR trials). Age alone (A) is not sufficient. BNP above 500 (C) and exercise-induced ST changes (D) are other triggers. LVEF below 60% (E) triggers a different recommendation.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease