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This advancement from the \u2018wear and tear\u2019 model is a result of the growing economic and health burden of AS, particularly within industrialised countries, prompting further research. The pathophysiology of calcific AS (CAS) is complex, yet can be characterised similarly to that of atherosclerosis. Progressive remodelling involves lipid-protein complexes, with lipoprotein(a) being of particular interest for diagnostics and potential future treatment options.<\/jats:p>\n               <jats:p>There is an unmet clinical need for asymptomatic patient management; no pharmacotherapies are proven to slow progression and intervention timing varies. Novel approaches are developing to address this through: (1) screening with circulating biomarkers; (2) development of drugs to slow disease progression and (3) early valve intervention guided by medical imaging. Existing biomarkers (troponin and brain natriuretic peptide) are non-specific, but cost-effective predictors of ventricular dysfunction. In addition, their integration with cardiovascular MRI can provide accurate risk stratification, aiding aortic valve replacement decision making. Currently, invasive intervention is the only treatment for AS. In comparison, the development of lipoprotein(a) lowering therapies could provide an alternative; slowing progression of CAS, preventing left ventricular dysfunction and reducing reliance on surgical intervention.<\/jats:p>\n               <jats:p>The landscape of AS management is rapidly evolving. This review outlines current understanding of the pathophysiology of AS, its management and future perspectives for the condition\u2019s assessment and treatment.<\/jats:p>","DOI":"10.1136\/openhrt-2022-002244","type":"journal-article","created":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T11:25:32Z","timestamp":1679657132000},"page":"e002244","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":23,"title":["Pathophysiology, emerging techniques for the assessment and novel treatment of aortic stenosis"],"prefix":"10.1136","volume":"10","author":[{"given":"Syed Muneeb","family":"Shah","sequence":"first","affiliation":[{"name":"School of Medicine, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Shah","sequence":"additional","affiliation":[{"name":"School of Medicine, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1724-6539","authenticated-orcid":false,"given":"Samuel Mark","family":"Lakey","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pankaj","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular and Metabolic Health, Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK"},{"name":"Department of Cardiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Paul","family":"Ripley","sequence":"additional","affiliation":[{"name":"School of Medicine, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK"},{"name":"Department of Cardiology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,3,24]]},"reference":[{"key":"2025081710130853000_10.1.e002244.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx391"},{"key":"2025081710130853000_10.1.e002244.2","doi-asserted-by":"crossref","first-page":"29","DOI":"10.2174\/157340309787048103","article-title":"Management of asymptomatic severe aortic stenosis","volume":"5","author":"Stewart","year":"2009","journal-title":"Curr Cardiol Rev"},{"key":"2025081710130853000_10.1.e002244.3","doi-asserted-by":"crossref","unstructured":"Bohbot Y , Renard C , Manrique A , et al . 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