Multimodality Imaging in Aortic Stenosis : Beyond the Valve - Focusing on the Myocardium - 21/06/24

Doi : 10.1016/j.ccl.2024.04.002

Safwan Gaznabi, MD ^a,^b, Jeirym Miranda, MD ^a,^c, Daniel Lorenzatti, MD ^a, Pamela Piña, MD ^a,^d, Senthil S. Balasubramanian, MD ^b, Darshi Desai, MD ^e, Aditya Desai, MD ^e, Edwin C. Ho, MD ^a, Andrea Scotti, MD ^a, Carlos A. Gongora, MD ^a, Aldo L. Schenone, MD ^a, Mario J. Garcia, MD ^a, Azeem Latib, MD ^a, Purvi Parwani, MBBS, MPH ^f, Leandro Slipczuk, MD, PhD ^a,^⁎
^a Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 111 East 210th street, Bronx, NY 10467, USA
^b Division of Cardiology, University of Chicago at Northshore University Health System, 1000 Central Street, Evanston, IL 60201, USA
^c Division of Cardiology, Mount Sinai Morningside. 419 West 114th Street, NY 10025, USA
^d Division of Cardiology, CEDIMAT. Arturo Logroño, Plaza de la Salud, Dr. Juan Manuel Taveras Rodríguez, C. Pepillo Salcedo esq. Santo Domingo, Dominican Republic
^e Department of Internal Medicine, University of California Riverside School of Medicine. 900 University Avenue, Riverside, CA 92521, USA
^f Division of Cardiology, Department of Medicine, Loma Linda University Health, 11234 Anderson Street, Loma Linda, CA 92354, USA

^∗Corresponding author. Division of Cardiology, Montefiore Medical Center, 111 East 210th street, Bronx, NY 10467.Division of CardiologyMontefiore Medical Center111 East 210th streetBronxNY10467

Résumé

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.

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Keywords : Aortic stenosis, Low flow low gradient, Discordant, Asymptomatic, Global longitudinal strain, Fibrosis, Myocardium

Plan

Key points

Beyond a valve-focused assessment and management of aortic stenosis

Challenges of discordant echocardiographic findings

Asymptomatic severe aortic stenosis and the myocardium

Effects of moderate aortic stenosis on the myocardium

Aortic stenosis and cardiac amyloidosis

Utilization of fluorodeoxyglucose PET in evaluation of aortic stenosis

Future perspectives

Clinics care points

Disclosure

This article originally appeared in Interventional Cardiology Clinics Vol. 13 Issue 1 p101–114 Published in issue: January, 2024.
This article originally appeared in Heart Failure Clinics, Volume 19 Issue 4, October 2023.