Abstract
Aortic stenosis has an increasing prevalence in the context of aging population. In these patients non-invasive imaging allows not only the grading of valve stenosis severity, but also the assessment of left ventricular function. These two goals play a key role in clinical decision-making. Although left ventricular ejection fraction is currently the only left ventricular function parameter that guides intervention, current imaging techniques are able to detect early changes in LV structure and function even in asymptomatic patients with significant aortic stenosis and preserved ejection fraction. Moreover, new imaging parameters emerged as predictors of disease progression in patients with aortic stenosis. Although proper standardization and confirmatory data from large prospective studies are needed, these novel parameters have the potential of becoming useful tools in guiding intervention in asymptomatic patients with aortic stenosis and stratify risk in symptomatic patients undergoing aortic valve replacement.This review focuses on the mechanisms of transition from compensatory left ventricular hypertrophy to left ventricular dysfunction and heart failure in aortic stenosis and the role of non-invasive imaging assessment of the left ventricular geometry and function in these patients.
Highlights
Aortic stenosis (AS) is the third most common cardiovascular disease in Western countries and the main indication for valve replacement in adult patients [1]
- allows the assessment of left ventricular (LV) volumes and global LV function - wider availability when compared to cardiac magnetic resonance imaging (CMR)
Conclusions and future perspectives The consequences of increased afterload on the LV should always be taken into account for a comprehensive assessment of patients with AS
Summary
Aortic stenosis (AS) is the third most common cardiovascular disease in Western countries and the main indication for valve replacement in adult patients [1]. Impaired coronary flow reserve and inadequate subendocardial blood flow are found in patients with AS even in the absence of significant coronary artery disease [18] These are related to the severity of AS, haemodynamic load on the LV, and reduced diastolic perfusion time, rather than to the increase in LV mass [18] and may represent the substrate for LV longitudinal dysfunction. Echocardiographic parameters of longitudinal LV function (such as MAPSE and GLS) allow an indirect assessment of fibrotic changes in patients with AS They are surrogate markers of the presence and severity of myocardial fibrosis and are superior to LVEF in the assessment of latent LV dysfunction. Prognostic significance of left ventricular remodelling in aortic stenosis Current guidelines strongly recommend AVR in all patients with severe AS when associated with either symptom related to AS or an abnormal LVEF (
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