Abstract
Calcific aortic valve disease is the most common valvular disease and confers significant morbidity and mortality. There are currently no medical therapies that successfully halt or reverse the disease progression, making surgical replacement the only treatment currently available. The majority of patients will receive a bioprosthetic valve, which themselves are prone to degeneration and may also need replaced, adding to the already substantial healthcare burden of aortic stenosis. Echocardiography and computed tomography can identify late-stage manifestations of the disease process affecting native and bioprosthetic aortic valves but cannot detect or quantify early molecular changes. 18F-fluoride positron emission tomography, on the other hand, can non-invasively and sensitively assess disease activity in the valves. The current review outlines the pivotal role this novel molecular imaging technique has played in improving our understanding of native and bioprosthetic aortic valve disease, as well as providing insights into its feasibility as an important future research and clinical tool.
Highlights
Aortic stenosis affects 1-2% of the general population [65 years old, conferring with it increased mortality.[1,2] Current international guidance recommends that the aortic valve should be replacement in those with severe, symptomatic aortic stenosis; a procedure which carries morbidity and significant cost.[1,3,4,5] Replacement with a bioprosthetic valve is recommended in those over 65-70 years old, with mechanical valves preferred in the minority of younger patients.[6]
Increasing haemodynamic resistance across the valve can be identified with transthoracic echocardiography (TTE), while end-stage structural valve disease can be seen as valvular calcification identified on computed tomography (CT)
The results demonstrated that calcification activity dominated over inflammation in aortic stenosis, in the latter stages of moderate or severe stenosis (Fig. 1).[10]
Summary
Detecting native and bioprosthetic aortic valve disease using 18F-sodium fluoride: Clinical implications. The majority of patients will receive a bioprosthetic valve, which themselves are prone to degeneration and may need replaced, adding to the already substantial healthcare burden of aortic stenosis. Echocardiography and computed tomography can identify late-stage manifestations of the disease process affecting native and bioprosthetic aortic valves but cannot detect or quantify early molecular changes. 18F-fluoride positron emission tomography, on the other hand, can non-invasively and sensitively assess disease activity in the valves. The current review outlines the pivotal role this novel molecular imaging technique has played in improving our understanding of native and bioprosthetic aortic valve disease, as well as providing insights into its feasibility as an important future research and clinical tool
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