Multimodality Imaging in Aortic Stenosis: Beyond the Valve - Focusing on the Myocardium

• Published in: Cardiology clinics Vol. 42; no. 3; p. 433
• Main Authors: Gaznabi, Safwan, Miranda, Jeirym, Lorenzatti, Daniel, Piña, Pamela, Balasubramanian, Senthil S, Desai, Darshi, Desai, Aditya, Ho, Edwin C, Scotti, Andrea, Gongora, Carlos A, Schenone, Aldo L, Garcia, Mario J, Latib, Azeem, Parwani, Purvi, Slipczuk, Leandro
• Format: Journal Article
• Language: English
• Published: Netherlands 01-08-2024
• Subjects: Aortic Valve - diagnostic imaging; Aortic Valve - pathology; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - physiopathology; Humans; Magnetic Resonance Imaging, Cine - methods; Multimodal Imaging - methods; Myocardium - pathology; Aortic stenosis; Fibrosis; Myocardium; Discordant; Asymptomatic; Global longitudinal strain; Low flow low gradient
• ISSN: 1558-2264; 1558-2264
• DOI: 10.1016/j.ccl.2024.04.002

Current guidelines of aortic stenosis (AS) management focus on valve parameters, LV systolic dysfunction, and symptoms; however, emerging data suggest that there may be benefit of aortic valve replacement before it becomes severe by present criteria. Myocardial assessment using novel multimodality imaging techniques exhibits subclinical myocardial injury and remodeling at various stages before guideline-directed interventions, which predicts adverse outcomes. This raises the question of whether implementing serial myocardial assessment should become part of the standard appraisal, thereby identifying high-risk patients aiming to minimize adverse outcomes.