scholarly journals P349 Utility and prognostic value of aortic valve area by magnetic resonance imaging in patients with aortic stenosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
B Igual Munoz ◽  
O B H Oscar Blanco Herrera ◽  
F J V M Francisco Jose Valera Martinez ◽  
D D V Diana Domingo Valero ◽  
P S S Pilar Sepulveda Sanchez ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Phase Contrast ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Valve Area

Abstract Classically clinical evaluation of patients with aortic stenosis (AS) is made using clinical and echocardiographic parameters but recently new imaging techniques as cardiovascular magnetic resonance (CMR ) are being used increasingly in this clinical setting. We aim to assess utility and prognostic value of aortic valve area (AVA) by CMR in patients with AS regarding echocardiographic data. METHODS a retrospective cohort of patients with AS referred to CMR and cardiac echocardiography study for evaluation were included. Patients with known coronary artery disease or another significant valve disease were excluded. Clinical Follow up was performed to asses cardiovascular death, hospital admission or aortic valve replacement at the first year after imaging evaluation. Furthermore symptomatic status was assessed. Echocardiographic severity was estimated used peak and mean gradients . Additionally a CMR study including b-SSFPS for left ventricle ejection fraction (LVEF) quantification and phase-contrast sequences acquired at aortic valve plane to analyze aortic valve area (AVA) by planimetry was performed. RESULTS ninety eight patients, mean age 67+ 15 years, 52(58%) males, 23 (25%) with decreased left ventricular ejection fraction. A significant negative correlation was observed between AVA by CMR and echocardiographic gradients ( -0.49 for mean gradient and -0.58 for peak gradient). AVA was strongly associated to symptomatic status (AUROC curve 0.66, p < 0.001). A multivariate logistic regression model including echocardiographic gradients,CMR, LVEF and AVA was performed and mean gradient ( OR:1.02 p = 0.01) and AVA (OR: 0.002 p = 0.001) were shown to be independent predictors of events. Conclusion 1.AVA by planimetry in phase-contrast CMR sequences is a valid tool to asses severity of aortic valve stenosis . 2 AVA was strongly associated to symptomatic status.3. AVA has proven to have additional prognostic value beyond echocardiographic gradients. Abstract P349 Figure. Aortic valve area by planimetry by MR

scholarly journals Clinical Value of Stress Transaortic Flow Rate During Dobutamine Echocardiography in Reduced Left Ventricular Ejection Fraction, Low-Gradient Aortic Stenosis: A Multicenter Study

2021 ◽  
Author(s):  
Anastasia Vamvakidou ◽  
Mohamed-Salah Annabi ◽  
Phillipe Pibarot ◽  
Edyta Plonska-Gosciniak ◽  
Ana G. Almeida ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Ventricular Ejection Fraction ◽  
Valve Area

Background: Low rest transaortic flow rate (FR) has been shown previously to predict mortality in low-gradient aortic stenosis. However limited prognostic data exists on stress FR during low-dose dobutamine stress echocardiography. We aimed to assess the value of stress FR for the detection of aortic valve stenosis (AS) severity and the prediction of mortality. Methods: This is a multicenter cohort study of patients with reduced left ventricular ejection fraction and low-gradient aortic stenosis (aortic valve area <1 cm 2 and mean gradient <40 mm Hg) who underwent low-dose dobutamine stress echocardiography to identify the AS severity and presence of flow reserve. The outcome assessed was all-cause mortality. Results: Of the 287 patients (mean age, 75±10 years; males, 71%; left ventricular ejection fraction, 31±10%) over a mean follow-up of 24±30 months there were 127 (44.3%) deaths and 147 (51.2%) patients underwent aortic valve intervention. Higher stress FR was independently associated with reduced risk of mortality (hazard ratio, 0.97 [95% CI, 0.94–0.99]; P =0.01) after adjusting for age, chronic kidney disease, heart failure symptoms, aortic valve intervention, and rest left ventricular ejection fraction. The minimum cutoff for prediction of mortality was stress FR 210 mL/s. Following adjustment to the same important clinical and echocardiographic parameters, among the three criteria of AS severity during stress, ie, the guideline definition of aortic valve area <1cm 2 and aortic valve mean gradient ≥40 mm Hg, or aortic valve mean gradient ≥40 mm Hg, or the novel definition of aortic valve area <1 cm 2 at stress FR ≥210 mL/s, only the latter was independently associated with mortality (hazard ratio, 1.72 [95% CI, 1.05–2.82]; P =0.03). Furthermore aortic valve area <1cm 2 at stress FR ≥210 mL/s was the only severe aortic stenosis criterion that was associated with improved outcome following aortic valve intervention ( P <0.001). Guideline-defined stroke volume flow reserve did not predict mortality. Conclusions: Stress FR during low-dose dobutamine stress echocardiography was useful for the detection of both AS severity and flow reserve and was associated with improved prediction of outcome following aortic valve intervention.

scholarly journals Dimensionless Index in Patients With Low-Gradient Severe Aortic Stenosis and Preserved Ejection Fraction

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Alexandre Altes ◽  
Nicolas Thellier ◽  
Dan Rusinaru ◽  
Wassima Marsou ◽  
Yohann Bohbot ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Aortic Valve ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Ventricular Ejection Fraction ◽  
Valve Area

Background Risk stratification of patients with low-gradient (LG) severe aortic stenosis (AS) despite preserved left ventricular ejection fraction remains challenging. We sought to evaluate the relationship between the dimensionless index (DI)—the ratio of the left ventricular outflow tract time-velocity integral to that of the aortic valve jet—and mortality in these patients. Methods Seven hundred fifty-five patients with LG severe AS (defined by aortic valve area ≤1 cm 2 or aortic valve area indexed to body surface area ≤0.6 cm 2 /m 2 and mean aortic pressure gradient <40 mm Hg) and preserved left ventricular ejection fraction ≥50% were studied. Flow status was defined according to stroke volume index <35 mL/m 2 (low flow, LF) or ≥35 mL/m 2 (normal flow, NF). Results After adjustment for age, sex, body mass index, Charlson comorbidity index, history of hypertension, history of atrial fibrillation, AS-related symptoms, left ventricular ejection fraction, indexed left ventricular ventricular mass, aortic valve area, and aortic valve replacement as a time-dependent covariate, patients with LG-LF and DI<0.25 exhibited a considerable increased risk of death compared with patients with LG-NF and DI≥0.25 (adjusted hazard ratio, 2.41 [95% CI, 1.61–3.62]; P <0.001), LG-NF and DI<0.25 (adjusted hazard ratio, 1.84 [95% CI, 1.24–2.73]; P =0.003), and LG-LF and D≥0.25 (adjusted hazard ratio, 2.27 [95% CI, 1.42–3.63]; P <0.001). In contrast, patients with LG-LF and DI≥0.25, LG-NF and DI<0.25, and LG-NF and DI≥0.25 had similar outcome. DI<0.25 showed incremental prognostic value in patients with LG-LF severe AS but not in patients with LG-NF severe AS. Conclusions Among patients with LG severe AS and preserved left ventricular ejection fraction, decreased DI<0.25 is a reliable parameter in patients with LF to identify a subgroup of patients at higher risk of death who may derive benefit from aortic valve replacement.

scholarly journals Use of passive leg rise as an add-on to dobutamine in patients with paradoxical low-flow, low-gradient aortic stenosis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Buffle ◽  
A Papadis ◽  
C Seiler ◽  
S F De Marchi
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Low Flow ◽  
Volume Index ◽  
Aortic Valve Area ◽  
Low Ejection Fraction ◽  
Valve Area

Abstract Background Dobutamine has been proposed for the assessment of low-flow, low-gradient aortic stenosis (LFLGAS). However, in 1/3 of patients, no increase in stroke volume index can be achieved by Dobutamine, thus hampering its diagnostic value. This study evaluated the manoeuvre of cardiac preload augmentation by passive leg rise (PLR) alone or on top of Dobutamine to increase stroke volume index (SVI) in patients with LFLGAS, particularly in paradoxical LFLGAS. Methods We examined 50 patients with LFLGAS. Patients were assigned to the paradoxical LFLGAS (Paradox) group if left ventricular ejection fraction (LVEF) was ≥50% (n=29) and to the LFLGAS with low ejection fraction (LEF) group if LVEF was &lt;50% (n=21). A modified Dobutamine stress echocardiography was performed in all patients with the following 4 steps: Rest, PLR alone, maximal Dobutamine infusion rate alone (Dmax) and Dobutamine plus PLR (Dmax + PLR). Three SVI measurement methods were used: first the left ventricular outflow tract velocity time integral (LVOT VTI) method, second the 2D Simpson's method, and third the 3D method. The corresponding aortic valve area (AVA) was obtained by the continuity equation. The increase of those values compared to measurements at rest was calculated and compared between the 3 stress steps. Results In the paradoxical LFLGAS group, delta SVI with Dmax assessed by both Simpson's (depicted in the figures) and 3D method was lowest compared to PLR and Dmax + PLR. PLR alone yielded an equally high delta SVI as Dmax + PLR in Simpson's and 3D, and was at least as high as Dmax across all methods. Dobutamine alone yielded the lowest delta transaortic aortic valve VTI. The highest delta aortic valve area resulted for Dmax + PLR. In the LEF group, the three stress steps yielded an equally high delta SVI with Simpson's method. Dmax never yielded a higher delta SVI than PLR alone. The yielded delta SVI was the highest for Dmax + PLR for both LVOT VTI and 3d method, although the difference was overall not as strong as in the Paradox group. Conclusions In patients with paradoxical LFLGAS, Dobutamine alone is inadequate for testing the potential of aortic valve opening augmentation. Instead, PLR alone or the addition of PLR plus Dobutamine should be used for that purpose. In low LVEF, adding PLR to Dobutamine also seems useful although its diagnostic added value is less evident than in the Paradox group. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Gottfried und Julia Bangerter-Rhyner-Foundation Paradox group Low ejection fraction group

Clinical and echocardiographic outcomes of patients with moderate to severe aortic stenosis and preserved, mid-range and reduced ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Chew ◽  
N Ngiam ◽  
B.Y.Q Tan ◽  
C.H Sia ◽  
H.W Sim ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

Abstract Background Left ventricular ejection fraction (EF) plays an important role in risk stratifying and guiding therapy for patients with aortic stenosis (AS). This study aims to describe the clinical and echocardiographic outcomes of AS patients with preserved (ASpEF), mid-range (ASmrEF) and reduced (ASrEF) EF. Methods 713 consecutive patients with index echocardiographic diagnosis of moderate-severe AS (aortic valve area &lt;1.5cm2) were allocated according to the EF into three groups: ASrEF (EF&lt;40%), ASmrEF (EF 40–50%), and ASpEF (EF&gt;50%). The study outcomes were defined as 5-year all-cause mortality, heart failure admissions, and aortic valve replacement (AVR). Results In comparison to patients with ASpEF, those with ASrEF were more frequently male, and systolic blood pressure was significantly lower on enrolment (p&lt;0.001). Diabetes, ischemic heart disease and atrial fibrillation were more commonly seen in the ASrEF and ASmrEF groups, compared to ASpEF group. All-cause mortality rates were 30.5% for ASpEF, 50.8% for ASmrEF, 55.0% for ASrEF groups (p&lt;0.001). Increased rates of heart failure admissions were seen in the ASmrEF and ASrEF groups (30.5% and 33.9%, respectively, vs. 14.9% in ASpEF group). Patients with ASrEF had significantly higher rates of AVR as compared to those in the ASmrEF and ASpEF groups (p=0.032). Conclusion Echocardiographic and clinical outcomes of ASmrEF patients resembled those of ASrEF more closely than the ASpEF patients. Stratifying AS patients according to the different EF groups may improve risk assessment and treatment strategies. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals The evaluation of annuloplasty in bicuspid aortic valve repair using cardiac magnetic resonance

2020 ◽  
Author(s):  
Marek Jasinski ◽  
Karol Miszalski-Jamka ◽  
Radoslaw Gocol ◽  
Izabella Wenzel-Jasinska ◽  
Grzegorz Bielicki ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Reverse Remodeling ◽  
Aortic Valve Area ◽  
Valve Repair ◽  
Valve Area

Abstract Background: The incompetent bicuspid aortic valve (BAV) can be replaced or repaired using various surgical techniques. This study sought to assess the efficacy of external annuloplasty and postoperative reverse remodeling using cardiac magnetic resonance (CMR) and compare the mid-term results of external and subcommissural annuloplasty. Methods: Out of a total of 200 BAV repair performed between 2004 and 2018, 21 consecutive patients (median age 54 years) with regurgitation requiring valve repair with annuloplasty without concomitant aortic root surgery were prospectively referred for CMR and transthoracic echocardiography (TTE) one year after the operation. Two aortic annulus stabilization techniques were used: external, circumferential annuloplasty (EA), and subcommissural annuloplasty (SCA). Results: 11 patients received EA and 10 patients were treated using SCA. There was no in-hospital mortality and all patients survived the follow-up period. CMR showed strong correlation between postoperative aortic recurrent regurgitant fraction and left ventricular end-diastolic volume (r=0.62; p=0.003) as well as left ventricular ejection fraction (r=-0.53; p=0.01). Patients treated with EA as compared with SCA had larger anatomic aortic valve area measured by CMR (3.5cm2 (2.5; 4.0) vs. 2.5cm2 (2.0; 3.4); p=0.04). In both EA and SCA group, aortic valve area below 3.5cm2 correlated with no regurgitation recurrency. EA (vs. SCA) was associated with lower peak transvalvular aortic gradients (10mmHg (6; 17) vs. 21mmHg (15; 27); p=0.04). Conclusions: The repair of the bicuspid aortic valve provides significant mid-term postoperative reverse remodeling, provided no recurrent regurgitation and durable reduction annuloplasty can be achieved. External, circumferential annuloplasty is associated with better hemodynamics compared to subcommissural annuloplasty.

scholarly journals The evaluation of annuloplasty in bicuspid aortic valve repair using cardiac magnetic resonance

2020 ◽  
Author(s):  
Marek Jasinski ◽  
Karol Miszalski-Jamka ◽  
Kinga Kosiorowska ◽  
Radoslaw Gocol ◽  
Izabella Wenzel-Jasinska ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Valve Repair ◽  
Reverse Remodelling ◽  
Valve Area

Abstract Background: The incompetent bicuspid aortic valve (BAV) can be replaced or repaired using various surgical techniques. This study sought to assess the efficacy of external annuloplasty and postoperative reverse remodelling using cardiac magnetic resonance (CMR) and compare the results of external and subcommissural annuloplasty. Methods: Out of a total of 200 BAV repair performed between 2004 and 2018, 21 consecutive patients (median age 54 years) with regurgitation requiring valve repair with annuloplasty without concomitant aortic root surgery were prospectively referred for CMR and transthoracic echocardiography (TTE) one year after the operation. Two aortic annulus stabilization techniques were used: external, circumferential annuloplasty (EA), and subcommissural annuloplasty (SCA). Results: 11 patients received EA and 10 patients were treated using SCA. There was no in-hospital mortality and all patients survived the follow-up period (median: 12.6 months (first quartile: 6.6; third quartile: 14.1). CMR showed strong correlation between postoperative aortic recurrent regurgitant fraction and left ventricular end-diastolic volume (r = 0.62; p = 0.003) as well as left ventricular ejection fraction (r = -0.53; p = 0.01). Patients treated with EA as compared with SCA had larger anatomic aortic valve area measured by CMR (3.5 (2.5; 4.0) vs. 2.5 cm2 (2.0; 3.4); p = 0.04). In both EA and SCA group, aortic valve area below 3.5 cm2 correlated with no regurgitation recurrency. EA (vs. SCA) was associated with lower peak transvalvular aortic gradients (10 (6; 17) vs. 21mmHg (15; 27); p = 0.04). Conclusions: The repair of the bicuspid aortic valve provides significant postoperative reverse remodelling, provided no recurrent regurgitation and durable reduction annuloplasty can be achieved. EA is associated with lower transvalvular gradients and higher aortic valve area assessed by CMR, compared to SCA.

scholarly journals The evaluation of annuloplasty in bicuspid aortic valve repair using cardiac magnetic resonance

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marek J. Jasinski ◽  
Karol Miszalski-Jamka ◽  
Kinga Kosiorowska ◽  
Radoslaw Gocol ◽  
Izabella Wenzel-Jasinska ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Valve Repair ◽  
Reverse Remodelling ◽  
Valve Area

Abstract Background The incompetent bicuspid aortic valve (BAV) can be replaced or repaired using various surgical techniques. This study sought to assess the efficacy of external annuloplasty and postoperative reverse remodelling using cardiac magnetic resonance (CMR) and compare the results of external and subcommissural annuloplasty. Methods Out of a total of 200 BAV repair performed between 2004 and 2018, 21 consecutive patients (median age 54 years) with regurgitation requiring valve repair with annuloplasty without concomitant aortic root surgery were prospectively referred for CMR and transthoracic echocardiography (TTE) one year after the operation. Two aortic annulus stabilization techniques were used: external, circumferential annuloplasty (EA), and subcommissural annuloplasty (SCA). Results 11 patients received EA and 10 patients were treated using SCA. There was no in-hospital mortality and all patients survived the follow-up period (median: 12.6 months (first quartile: 6.6; third quartile: 14.1). CMR showed strong correlation between postoperative aortic recurrent regurgitant fraction and left ventricular end-diastolic volume (r = 0.62; p = 0.003) as well as left ventricular ejection fraction (r = -0.53; p = 0.01). Patients treated with EA as compared with SCA had larger anatomic aortic valve area measured by CMR (3.5 (2.5; 4.0) vs. 2.5 cm2 (2.0; 3.4); p = 0.04). In both EA and SCA group, aortic valve area below 3.5 cm2 correlated with no regurgitation recurrency. EA (vs. SCA) was associated with lower peak transvalvular aortic gradients (10 (6; 17) vs. 21 mmHg (15; 27); p = 0.04). Conclusions The repair of the bicuspid aortic valve provides significant postoperative reverse remodelling, provided no recurrent regurgitation and durable reduction annuloplasty can be achieved. EA is associated with lower transvalvular gradients and higher aortic valve area assessed by CMR, compared to SCA.

Abstract 15267: 1-Year Survival Post Trans-Catheter Aortic Replacement in Patients With Low and High-gradient Severe Aortic Valve Stenosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Caleb Chiang ◽  
Mohamad Hemu ◽  
Jaafar Alward ◽  
Konstantinos Voudris ◽  
Hassam Suradi
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Ventricular Ejection Fraction ◽  
High Gradient ◽  
Aortic Replacement ◽  
Significant Difference

Introduction: There is limited data on trans-catheter aortic replacement (TAVR) outcomes in patients with low gradient-preserved ejection fraction aortic stenosis (LGpEF). Our study aims to compare baseline characteristics and procedural outcomes in patients with LGpEF vs. high gradient severe aortic stenosis (HGAS). Methods: Patients who underwent TAVR at our institution were divided in 2 groups: 1) HGAS (aortic valve area (AVA) < 1cm 2 , mean gradient (MG) > 40 mmHg); 2) LGpEF (AVA < 1cm 2 , MG <40 mmHg, left ventricular ejection fraction ≥ 50%). Primary outcome included 1-year all-cause mortality post-TAVR. Multivariable cox proportional hazards model was adjusted for covariates of clinical significance (age, Society of Thoracic Surgery (STS) score, chronic kidney disease (GFR < 60 mL/min/1.73m2), para-valvular leak (PVL) day 1 post-TAVR, and baseline New York Heart Association (NYHA) class. Results: A total of 140 patients with HGAS (53% female, 81±9 years old) and 73 patients with LGAS (51% female, 80±9.5 years old) were identified. In multivariable analyses, there was no statistically significant difference in mortality between HGAS vs. LGpEF (HR 0.53, 95% CI 0.21-1.3; p=0.16) (Figure). PVL was independently associated with increased mortality in HGAS (HR 2.9, 95% CI 1.2-7.3; p=0.02) but this effect was not observed in patients with LGpEF. Conclusions: After adjusting for relevant patient characteristics, TAVR outcomes in patients with LGpEF were similar to those with HGAS at 1-year follow-up.

scholarly journals Imaging Challenges in Patients with Severe Aortic Stenosis and Heart Failure: Did We Find a Way Out of the Labyrinth?

2022 ◽  
Vol 11 (2) ◽  
pp. 317
Author(s):  
Birgid Gonska ◽  
Dominik Buckert ◽  
Johannes Mörike ◽  
Dominik Scharnbeck ◽  
Johannes Kersten ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Left Ventricular ◽  
Low Flow ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Ventricular Ejection Fraction ◽  
Valve Area

Aortic stenosis (AS) is the most frequent degenerative valvular disease in developed countries. Its incidence has been constantly rising due to population aging. The diagnosis of AS was considered straightforward for a very long time. High gradients and reduced aortic valve area were considered as “sine qua non” in diagnosis of AS until a growing body of evidence showed that patients with low gradients could also have severe AS with the same or even worse outcome. This completely changed the paradigm of AS diagnosis and involved large numbers of parameters that had never been used in the evaluation of AS severity. Low gradient AS patients may present with heart failure (HF) with preserved or reduced left ventricular ejection fraction (LVEF), associated with changes in cardiac output and flow across the aortic valve. These patients with low-flow low-gradient or paradoxical low-flow low-gradient AS are particularly challenging to diagnose, and cardiac output and flow across the aortic valve have become the most relevant parameters in evaluation of AS, besides gradients and aortic valve area. The introduction of other imaging modalities in the diagnosis of AS significantly improved our knowledge about cardiac mechanics, tissue characterization of myocardium, calcium and inflammation burden of the aortic valve, and their impact on severity, progression and prognosis of AS, not only in symptomatic but also in asymptomatic patients. However, a variety of novel parameters also brought uncertainty regarding the clinical relevance of these indices, as well as the necessity for their validation in everyday practice. The aim of this review is to summarize the prevalence of HF in patients with severe AS and elaborate on the diagnostic challenges and advantages of comprehensive multimodality cardiac imaging to identify the patients that may benefit from surgical or transcatheter aortic valve replacement, as well as parameters that may help during follow-up.

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