Prevalence and clinical implications of angiodysplasia in patients with aortic stenosis: a systematic review and meta-analysis

Gastrointestinal angiodysplasia is frequently observed in patients with aortic stenosis and may present with bleeding and anemia. We conducted a systematic review and meta-analysis to estimate its prevalence in this population and to summarize outcomes after valve intervention. Following PRISMA 2020, we searched PubMed, Scopus, and Web of Science and registered the protocol in PROSPERO (CRD42024550839). Eligible observational studies reporting angiodysplasia, von Willebrand factor abnormalities, or both in aortic stenosis were appraised for quality and pooled using a random effects model; heterogeneity and publication bias were assessed with I ² and Egger's test. Eleven studies were included. The pooled prevalence of gastrointestinal angiodysplasia among patients with aortic stenosis was 6.3% (95% confidence interval: 4.51-8.38, I ² = 98.68, P < 0.0001), with no evidence of publication bias. Across studies that reported longitudinal outcomes, aortic valve replacement or transcatheter aortic valve implantation was associated with a reduction in lesion burden and lower rates of gastrointestinal bleeding, anemia, transfusion, and readmission, although early postprocedural bleeding could occur and typically declined over follow-up. These findings indicate that angiodysplasia is a clinically relevant comorbidity in aortic stenosis and support proactive gastrointestinal evaluation in patients with anemia or unexplained bleeding. Standardized diagnostic criteria and prospective studies are needed to clarify long-term outcomes after valve therapy and to define screening and management pathways.