Key Points
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Multimodality imaging has provided important insights in the pathophysiology of mitral regurgitation, aortic stenosis, and aortic regurgitation
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Grading the severity of valve dysfunction is an important step in the management of patients with valvular heart disease and, at present, echocardiography, computed tomography, and cardiac magnetic resonance are important diagnostic tools
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Strain imaging with echocardiography and tissue characterization with late gadolinium enhanced cardiac magnetic resonance have prognostic value in patients with valvular heart disease
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Accumulating data show that the extent of fibrosis associated with severe VHD has important prognostic implications
Abstract
Although echocardiography remains the mainstay imaging technique for the evaluation of patients with valvular heart disease (VHD), innovations in noninvasive imaging in the past few years have provided new insights into the pathophysiology and quantification of VHD, early detection of left ventricular (LV) dysfunction, and advanced prognostic assessment. The severity grading of valve dysfunction has been refined with the use of Doppler echocardiography, cardiac magnetic resonance (CMR), and CT imaging. LV ejection fraction remains an important criterion when deciding whether patients should be referred for surgery. However, echocardiographic strain imaging can now detect impaired LV systolic function before LV ejection fraction reduces, thus provoking the debate on whether patients with severe VHD should be referred for surgery at an earlier stage (before symptom onset). Impaired LV strain correlates with the amount of myocardial fibrosis detected with CMR techniques. Furthermore, accumulating data show that the extent of fibrosis associated with severe VHD has important prognostic implications. The present Review focuses on using these novel imaging modalities to assess pathophysiology, early LV dysfunction, and prognosis of major VHDs, including aortic stenosis, mitral regurgitation, and aortic regurgitation.
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The Department of Cardiology of the Leiden University Medical Center, Netherlands received research grants from Biotronik, Boston Scientific, Edwards Lifesciences, and Medtronic. V.D. received speaker fees from Abbott Vascular. J.J.B. declares no competing interests.
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Bax, J., Delgado, V. Advanced imaging in valvular heart disease. Nat Rev Cardiol 14, 209–223 (2017). https://doi.org/10.1038/nrcardio.2017.1
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DOI: https://doi.org/10.1038/nrcardio.2017.1
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