[en] In this EACVI clinical scientific update, we will explore the current use of multi-modality imaging in the diagnosis, risk stratification, and follow-up of patients with aortic stenosis, with a particular focus on recent developments and future directions. Echocardiography is and will likely remain the key method of diagnosis and surveillance of aortic stenosis providing detailed assessments of valve haemodynamics and the cardiac remodelling response. Computed tomography (CT) is already widely used in the planning of transcutaneous aortic valve implantation. We anticipate its increased use as an anatomical adjudicator to clarify disease severity in patients with discordant echocardiographic measurements. CT calcium scoring is currently used for this purpose; however, contrast CT techniques are emerging that allow identification of both calcific and fibrotic valve thickening. Additionally, improved assessments of myocardial decompensation with echocardiography, cardiac magnetic resonance, and CT will become more commonplace in our routine assessment of aortic stenosis. Underpinning all of this will be widespread application of artificial intelligence. In combination, we believe this new era of multi-modality imaging in aortic stenosis will improve the diagnosis, follow-up, and timing of intervention in aortic stenosis as well as potentially accelerate the development of the novel pharmacological treatments required for this disease.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Dweck, Marc R ; Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK.
Loganath, Krithika; Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK.
Bing, Rong ; Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK.
Treibel, Thomas A; Barts Heart Centre, Bart's Health NHS Trust, W Smithfield, EC1A 7BE, London, UK. ; University College London Institute of Cardiovascular Science, 62 Huntley St, WC1E 6DD, London, UK.
McCann, Gerry P ; Department of Cardiovascular Sciences, University of Leicester, University Rd, Leicester LE1 7RH, UK. ; The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK.
Newby, David E; Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh, EH16 4SB, UK.
Leipsic, Jonathon; Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, 1081 Burrard St Room 166, Vancouver, British Columbia V6Z 1Y6, Canada.
Fraccaro, Chiara; Department of Cardiac, Thoracic and Vascular Science and Public Health, Via Giustiniani, 2 - 35128, Padua, Italy.
Paolisso, Pasquale ; Cardiovascular Center Aalst, OLV Clinic, Moorselbaan 164, 9300 Aalst, Belgium. ; Department of Advanced Biomedical Sciences, University of Naples, Federico II, 80125 Naples, Italy.
Cosyns, Bernard; Department of Cardiology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium.
Habib, Gilbert ; Cardiology Department, Hôpital La Timone, 264 Rue Saint-Pierre, 13005 Marseille, France.
Cavalcante, João; Allina Health Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th St, Minneapolis, MN 55407, USA.
Donal, Erwan ; Cardiology and CIC, Université Rennes, 2 Rue Henri Le Guilloux, 35033 Rennes, France.
Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation ; Gruppo Villa Maria Care and Research, Corso Giuseppe Garibaldi, 11, 48022 Lugo RA, Italy.
Clavel, Marie-Annick ; Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada. ; Faculté de Médecine-Département de Médecine, Université Laval, Ferdinand Vandry Pavillon, 1050 Av. de la Médecine, Québec City, Quebec G1V 0A6, Canada.
Otto, Catherine M; Division of Cardiology, Department of Medicine, University of Washington School of Medicine, 4333 Brooklyn Ave NE Box 359458, Seattle, WA 98195-9458, USA.
Pibarot, Phillipe; Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada.
Osnabrugge RLJ, Mylotte D, Head SJ, Van Mieghem NM, Nkomo VT, LeReun CM et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol 2013;62:1002-12.
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease: developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2021;43:561-632.
Otto CM, Kuusisto J, Reichenbach DD, Gown AM, O'Brien KD. Characterization of the early lesion of 'degenerative' valvular aortic stenosis. Histological and immunohistochemical studies. Circulation 1994;90:844-53.
Pawade TA, Newby DE, Dweck MR. Calcification in aortic stenosis: the skeleton key. J Am Coll Cardiol 2015;66:561-77.
Nazarzadeh M, Pinho-Gomes AC, Smith Byrne K, Canoy D, Raimondi F, Ayala Solares JR et al. Systolic blood pressure and risk of valvular heart disease: a Mendelian randomization study. JAMA Cardiol 2019;4:788-95.
Katz R, Wong ND, Kronmal R, Takasu J, Shavelle DM, Probstfield JL et al. Features of the metabolic syndrome and diabetes mellitus as predictors of aortic valve calcification in the Multi-Ethnic Study of Atherosclerosis. Circulation 2006;113:2113-9.
Chambers J. The left ventricle in aortic stenosis: evidence for the use of ACE inhibitors. Heart 2006;92:420-3.
Griffith MJ, Carey CM, Byrne JC, Coltart DJ, Jenkins BS, Webb-Peploe MM. Echocardiographic left ventricular wall thickness: a poor predictor of the severity of aortic valve stenosis. Clin Cardiol 1991;14:227-31.
Heymans S, Schroen B, Vermeersch P, Milting H, Gao F, Kassner A et al. Increased cardiac expression of tissue inhibitor of metalloproteinase-1 and tissue inhibitor of metalloproteinase-2 is related to cardiac fibrosis and dysfunction in the chronic pressure-overloaded human heart. Circulation 2005;112:1136-44.
Paolisso P, Gallinoro E, Vanderheyden M, Esposito G, Bertolone DT, Belmonte M et al. Absolute coronary flow and microvascular resistance reserve in patients with severe aortic stenosis. Heart 2023;109:47-54.
Balciunaite G, Rimkus A, Zurauskas E, Zaremba T, Palionis D, Valeviciene N et al. Transthyretin cardiac amyloidosis in aortic stenosis: prevalence, diagnostic challenges, and clinical implications. Hellenic J Cardiol 2020;61:92-8.
Zhao L, Buxbaum JN, Reixach N. Age-related oxidative modifications of transthyretin modulate its amyloidogenicity. Biochemistry 2013;52:1913-26.
Kristen AV, Schnabel PA, Winter B, Helmke BM, Longerich T, Hardt S et al. High prevalence of amyloid in 150 surgically removed heart valves-a comparison of histological and clinical data reveals a correlation to atheroinflammatory conditions. Cardiovasc Pathol 2010;19:228-35.
Michelena HI, Della Corte A, Evangelista A, Maleszewski JJ, Edwards WD, Roman MJ et al. International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes. J Thorac Cardiovasc Surg 2021;162:e383-414.
Sievers H-H, Schmidtke C. A classification system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg 2007;133:1226-33.
Baumgartner HC, Hung JC-C, Bermejo J, Chambers JB, Edvardsen T, Goldstein S et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2017;18: 254-75.
Hahn RT, Pibarot P. Accurate measurement of left ventricular outflow tract diameter: comment on the updated recommendations for the echocardiographic assessment of aortic valve stenosis. J Am Soc Echocardiogr 2017;30:1038-41.
Altes A, Thellier N, Rusinaru D, Marsou W, Bohbot Y, Chadha G et al. Dimensionless index in patients with low-gradient severe aortic stenosis and preserved ejection fraction. Circ Cardiovasc Imaging 2020;13:e010925.
Delgado V, Clavel MA, Hahn RT, Gillam L, Bax J, Sengupta PP et al. How do we reconcile echocardiography, computed tomography, and hybrid imaging in assessing discordant grading of aortic stenosis severity? JACC Cardiovasc Imaging 2019;12:267-82.
Berthelot-Richer M, Pibarot P, Capoulade R, Dumesnil JG, Dahou A, Thebault C et al. Discordant grading of aortic stenosis severity: echocardiographic predictors of survival benefit associated with aortic valve replacement. JACC Cardiovasc Imaging 2016;9: 797-805.
Altes A, Ringle A, Bohbot Y, Bouchot O, Appert L, Guerbaai RA et al. Clinical significance of energy loss index in patients with low-gradient severe aortic stenosis and preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2020;21:608-15.
Clavel MA, Burwash IG, Pibarot P. Cardiac imaging for assessing low-gradient severe aortic stenosis. JACC Cardiovasc Imaging 2017;10:185-202.
NG208 Ng. Heart valve disease presenting in adults: investigation and management; 2021.
Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 2017;38:2739-91.
Magne J, Cosyns B, Popescu BA, Carstensen HG, Dahl J, Desai MY et al. Distribution and prognostic significance of left ventricular global longitudinal strain in asymptomatic significant aortic stenosis: an individual participant data meta-analysis. JACC Cardiovasc Imaging 2019;12:84-92.
Gu H, Saeed S, Boguslavskyi A, Carr-White G, Chambers JB, Chowienczyk P. First-phase ejection fraction is a powerful predictor of adverse events in asymptomatic patients with aortic stenosis and preserved total ejection fraction. JACC Cardiovasc Imaging 2019;12:52-63.
Ong G, Pibarot P, Redfors B, Weissman NJ, Jaber WA, Makkar RR et al. Diastolic function and clinical outcomes after transcatheter aortic valve replacement: PARTNER 2 SAPIEN 3 registry. J Am Coll Cardiol 2020;76:2940-51.
Meimoun P, Djebali M, Botoro T, Djou Md U, Bidounga H, Elmkies F et al. Left atrial strain and distensibility in relation to left ventricular dysfunction and prognosis in aortic stenosis. Echocardiography 2019;36:469-77.
Lancellotti P, Magne J, Donal E, O'Connor K, Dulgheru R, Rosca M et al. Determinants and prognostic significance of exercise pulmonary hypertension in asymptomatic severe aortic stenosis. Circulation 2012;126:851-9.
Tastet L, Tribouilloy C, Maréchaux S, Vollema EM, Delgado V, Salaun E et al. Staging cardiac damage in patients with asymptomatic aortic valve stenosis. J Am Coll Cardiol 2019;74:550-63.
Fukui M, Gupta A, Abdelkarim I, Sharbaugh MS, Althouse AD, Elzomor H et al. Association of structural and functional cardiac changes with transcatheter aortic valve replacement outcomes in patients with aortic stenosis. JAMA Cardiol 2019;4:215-22.
Généreux P, Pibarot P, Redfors B, Mack MJ, Makkar RR, Jaber WA et al. Staging classification of aortic stenosis based on the extent of cardiac damage. Eur Heart J 2017;38: 3351-8.
Clavel MA, Messika-Zeitoun D, Pibarot P, Aggarwal SR, Malouf J, Araoz PA et al. The complex nature of discordant severe calcified aortic valve disease grading: new insights from combined Doppler echocardiographic and computed tomographic study. J Am Coll Cardiol 2013;62:2329-38.
Guzzetti E, Oh JK, Shen M, Dweck MR, Poh KK, Abbas AE et al. Validation of aortic valve calcium quantification thresholds measured by computed tomography in Asian patients with calcific aortic stenosis. Eur Heart J Cardiovasc Imaging 2022;23:717-26.
Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F 3rd et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021;143: e35-71.
Pawade T, Sheth T, Guzzetti E, Dweck MR, Clavel MA. Why and how to measure aortic valve calcification in patients with aortic stenosis. JACC Cardiovasc Imaging 2019;12: 1835-48.
Pawade T, Clavel MA, Tribouilloy C, Dreyfus J, Mathieu T, Tastet L et al. Computed tomography aortic valve calcium scoring in patients with aortic stenosis. Circ Cardiovasc Imaging 2018;11:e007146.
Khurrami L, Møller JE, Lindholt JS, Dahl JS, Fredgart MH, Obel LM et al. Aortic valve calcification among elderly males from the general population, associated echocardiographic findings, and clinical implications. Eur Heart J Cardiovasc Imaging 2022;23: 177-84.
Blanke P, Reinöhl J, Schlensak C, Siepe M, Pache G, Euringer W et al. Prosthesis oversizing in balloon-expandable transcatheter aortic valve implantation is associated with contained rupture of the aortic root. Circ Cardiovasc Interv 2012;5:540-8.
Salgado RA, Leipsic JA, Shivalkar B, Ardies L, Van Herck PL, Op de Beeck BJ et al. Preprocedural CT evaluation of transcatheter aortic valve replacement: what the radiologist needs to know. Radiographics 2014;34:1491-514.
Blanke P, Weir-McCall JR, Achenbach S, Delgado V, Hausleiter J, Jilaihawi H et al. Computed tomography imaging in the context of transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR): an expert consensus document of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2019;13:1-20.
Goenka AH, Schoenhagen P, Bolen MA, Desai MY. Multidimensional MDCT angiography in the context of transcatheter aortic valve implantation. AJR Am J Roentgenol 2014;203:749-58.
Bloomfield GS, Gillam LD, Hahn RT, Kapadia S, Leipsic J, Lerakis S et al. A practical guide to multimodality imaging of transcatheter aortic valve replacement. JACC Cardiovasc Imaging 2012;5:441-55.
Gurvitch R, Webb JG, Yuan R, Johnson M, Hague C, Willson AB et al. Aortic annulus diameter determination by multidetector computed tomography: reproducibility, applicability, and implications for transcatheter aortic valve implantation. JACC Cardiovasc Interv 2011;4:1235-45.
Kasel AM, Cassese S, Bleiziffer S, Amaki M, Hahn RT, Kastrati A et al. Standardized imaging for aortic annular sizing: implications for transcatheter valve selection. JACC Cardiovasc Imaging 2013;6:249-62.
Paolisso P, Gallinoro E, Andreini D, Mileva N, Esposito G, Bermpeis K et al. Prospective evaluation of the learning curve and diagnostic accuracy for pre-TAVI cardiac computed tomography analysis by cardiologists in training: the LEARN-CT study. J Cardiovasc Comput Tomogr 2022;16:404-11.
Cartlidge TR, Bing R, Kwiecinski J, Guzzetti E, Pawade TA, Doris MK et al. Contrast-enhanced computed tomography assessment of aortic stenosis. Heart 2021;107:1905-11.
Pandey NN, Sharma S, Jagia P, Gulati GS, Kumar S. Feasibility and accuracy of aortic valve calcium quantification on computed tomographic angiography in aortic stenosis. Ann Thorac Surg 2020;110:537-44.
Simard L, Cote N, Dagenais F, Mathieu P, Couture C, Trahan S et al. Sex-related discordance between aortic valve calcification and hemodynamic severity of aortic stenosis: is valvular fibrosis the explanation? Circ Res 2017;120:681-91.
Scully PR, Patel KP, Saberwal B, Klotz E, Augusto JB, Thornton GD et al. Identifying cardiac amyloid in aortic stenosis: ECV quantification by CT in TAVR patients. JACC Cardiovasc Imaging 2020;13:2177-89.
Suzuki M, Toba T, Izawa Y, Fujita H, Miwa K, Takahashi Y et al. Prognostic impact of myocardial extracellular volume fraction assessment using dual-energy computed tomography in patients treated with aortic valve replacement for severe aortic stenosis. J Am Heart Assoc 2021;10:e020655.
Vach M, Vogelhuber J, Weber M, Sprinkart AM, Pieper CC, Block W et al. Feasibility of CT-derived myocardial strain measurement in patients with advanced cardiac valve disease. Sci Rep 2021;11:8793.
Fukui M, Xu J, Thoma F, Sultan I, Mulukutla S, Elzomor H et al. Baseline global longitudinal strain by computed tomography is associated with post transcatheter aortic valve replacement outcomes. J Cardiovasc Comput Tomogr 2020;14:233-9.
Kramer CM, Barkhausen J, Bucciarelli-Ducci C, Flamm SD, Kim RJ, Nagel E. Standardized cardiovascular magnetic resonance imaging (CMR) protocols: 2020 update. J Cardiovasc Magn Reson 2020;22:17.
Keane MG, Wiegers SE, Plappert T, Pochettino A, Bavaria JE, Sutton MG. Bicuspid aortic valves are associated with aortic dilatation out of proportion to coexistent valvular lesions. Circulation 2000;102(19 Suppl 3):III35-9.
Myerson SG. Heart valve disease: investigation by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2012;14:7.
Clavel MA, Malouf J, Messika-Zeitoun D, Araoz PA, Michelena HI, Enriquez-Sarano M. Aortic valve area calculation in aortic stenosis by CT and Doppler echocardiography. JACC Cardiovasc Imaging 2015;8:248-57.
Halva R, Vaara SM, Peltonen JI, Kaasalainen TT, Holmstrom M, Lommi J et al. Peak flow measurements in patients with severe aortic stenosis: a prospective comparative study between cardiovascular magnetic resonance 2D and 4D flow and transthoracic echocardiography. J Cardiovasc Magn Reson 2021;23:132.
Chaturvedi A, Hobbs SK, Ling FS, Chaturvedi A, Knight P. MRI evaluation prior to transcatheter aortic valve implantation (TAVI): when to acquire and how to interpret. Insights Imaging 2016;7:245-54.
Sherif MA, Abdel-Wahab M, Beurich HW, Stocker B, Zachow D, Geist V et al. Haemodynamic evaluation of aortic regurgitation after transcatheter aortic valve implantation using cardiovascular magnetic resonance. EuroIntervention 2011;7:57-63.
Lorell BH, Carabello BA. Left ventricular hypertrophy: pathogenesis, detection, and prognosis. Circulation 2000;102:470-9.
Treibel TA, Lopez B, Gonzalez A, Menacho K, Schofield RS, Ravassa S et al. Reappraising myocardial fibrosis in severe aortic stenosis: an invasive and non-invasive study in 133 patients. Eur Heart J 2018;39:699-709.
Musa TA, Treibel TA, Vassiliou VS, Captur G, Singh A, Chin C et al. Myocardial scar and mortality in severe aortic stenosis: data from the BSCMR valve consortium. Circulation 2018;138:1935-47.
Lee S-P, Park S-J, Kim Y-J, Chang S-A, Park E-A, Kim H-K et al. Early detection of subclinical ventricular deterioration in aortic stenosis with cardiovascular magnetic resonance and echocardiography. J Cardiovasc Magn Reson 2013;15:72.
Everett RJ, Tastet L, Clavel MA, Chin CWL, Capoulade R, Vassiliou VS et al. Progression of hypertrophy and myocardial fibrosis in aortic stenosis: a multicenter cardiac magnetic resonance study. Circ Cardiovasc Imaging 2018;11:e007451.
Treibel TA, Kozor R, Schofield R, Benedetti G, Fontana M, Bhuva AN et al. Reverse myocardial remodeling following valve replacement in patients with aortic stenosis. J Am Coll Cardiol 2018;71:860-71.
Bing R, Everett RJ, Tuck C, Semple S, Lewis S, Harkess R et al. Rationale and design of the randomized, controlled early valve replacement guided by biomarkers of left ventricular decompensation in asymptomatic patients with severe aortic stenosis (EVOLVED) trial. Am Heart J 2019;212:91-100.
Maceira AM, Joshi J, Prasad SK, Moon JC, Perugini E, Harding I et al. Cardiovascular magnetic resonance in cardiac amyloidosis. Circulation 2005;111:186-93.
Cavalcante JL, Rijal S, Abdelkarim I, Althouse AD, Sharbaugh MS, Fridman Y et al. Cardiac amyloidosis is prevalent in older patients with aortic stenosis and carries worse prognosis. J Cardiovasc Magn Reson 2017;19:98.
Schwarz F, Flameng W, Schaper J, Hehrlein F. Correlation between myocardial structure and diastolic properties of the heart in chronic aortic valve disease: effects of corrective surgery. Am J Cardiol 1978;42:895-903.
Milano AD, Faggian G, Dodonov M, Golia G, Tomezzoli A, Bortolotti U et al. Prognostic value of myocardial fibrosis in patients with severe aortic valve stenosis. J Thorac Cardiovasc Surg 2012;144:830-7.
Kwak S, Everett RJ, Treibel TA, Yang S, Hwang D, Ko T et al. Markers of myocardial damage predict mortality in patients with aortic stenosis. J Am Coll Cardiol 2021;78:545-58.
Everett RJ, Treibel TA, Fukui M, Lee H, Rigolli M, Singh A et al. Extracellular myocardial volume in patients with aortic stenosis. J Am Coll Cardiol 2020;75:304-16.
Ahn J-H, Kim SM, Park S-J, Jeong DS, Woo M-A, Jung S-H et al. Coronary microvascular dysfunction as a mechanism of angina in severe AS: prospective adenosine-stress CMR study. J Am Coll Cardiol 2016;67:1412-22.
Steadman CD, Jerosch-Herold M, Grundy B, Rafelt S, Ng LL, Squire IB et al. Determinants and functional significance of myocardial perfusion reserve in severe aortic stenosis. JACC Cardiovasc Imaging 2012;5:182-9.
Singh A, Greenwood JP, Berry C, Dawson DK, Hogrefe K, Kelly DJ et al. Comparison of exercise testing and CMR measured myocardial perfusion reserve for predicting outcome in asymptomatic aortic stenosis: the PRognostic Importance of MIcrovascular Dysfunction in Aortic Stenosis (PRIMID AS) study. Eur Heart J 2017;38:1222-9.
Kellman P, Hansen MS, Nielles-Vallespin S, Nickander J, Themudo R, Ugander M et al. Myocardial perfusion cardiovascular magnetic resonance: optimized dual sequence and reconstruction for quantification. J Cardiovasc Magn Reson 2017;19:43.
Rost C, Korder S, Wasmeier G, Wu M, Klinghammer L, Flachskampf FA et al. Sequential changes in myocardial function after valve replacement for aortic stenosis by speckle tracking echocardiography. Eur J Echocardiogr 2010;11:584-9.
Dobson LE, Musa TA, Uddin A, Fairbairn TA, Swoboda PP, Erhayiem B et al. Acute reverse remodelling after transcatheter aortic valve implantation: a link between myocardial fibrosis and left ventricular mass regression. Can J Cardiol 2016;32:1411-8.
Fairbairn TA, Steadman CD, Mather AN, Motwani M, Blackman DJ, Plein S et al. Assessment of valve haemodynamics, reverse ventricular remodelling and myocardial fibrosis following transcatheter aortic valve implantation compared to surgical aortic valve replacement: a cardiovascular magnetic resonance study. Heart 2013;99: 1185-91.
Kim W-K, Rolf A, Liebetrau C, Van Linden A, Blumenstein J, Kempfert J et al. Detection of myocardial injury by CMR after transcatheter aortic valve replacement. J Am Coll Cardiol 2014;64:349-57.
Dobson LE, Musa TA, Uddin A, Fairbairn TA, Swoboda PP, Ripley DP et al. Post-procedural myocardial infarction following surgical aortic valve replacement and transcatheter aortic valve implantation. EuroIntervention 2017;13:e153-e60.
Gastl M, Behm P, Haberkorn S, Holzbach L, Veulemans V, Jacoby C et al. Role of T2 mapping in left ventricular reverse remodeling after TAVR. Int J Cardiol 2018;266: 262-8.
Mahmod M, Francis JM, Pal N, Lewis A, Dass S, De Silva R et al. Myocardial perfusion and oxygenation are impaired during stress in severe aortic stenosis and correlate with impaired energetics and subclinical left ventricular dysfunction. J Cardiovasc Magn Reson 2014;16:29.
Spath NB, Singh T, Papanastasiou G, Kershaw L, Baker AH, Janiczek RL et al. (November 17, 2020) Manganese-enhanced magnetic resonance imaging in dilated cardiomyopathy and hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging, doi:10.1093/ehjci/jeaa273
Meierhofer C, Schneider EP, Lyko C, Hutter A, Martinoff S, Markl M et al. Wall shear stress and flow patterns in the ascending aorta in patients with bicuspid aortic valves differ significantly from tricuspid aortic valves: a prospective study. Eur Heart J Cardiovasc Imaging 2013;14:797-804.
Nitsche C, Scully PR, Patel KP, Kammerlander AA, Koschutnik M, Dona C et al. Prevalence and outcomes of concomitant aortic stenosis and cardiac amyloidosis. J Am Coll Cardiol 2021;77:128-39.
Ternacle J, Krapf L, Mohty D, Magne J, Nguyen A, Galat A et al. Aortic stenosis and cardiac amyloidosis: JACC review topic of the week. J Am Coll Cardiol 2019;74: 2638-51.
Scully PR, Patel KP, Treibel TA, Thornton GD, Hughes RK, Chadalavada S et al. Prevalence and outcome of dual aortic stenosis and cardiac amyloid pathology in patients referred for transcatheter aortic valve implantation. Eur Heart J 2020;41: 2759-67.
Garcia-Pavia P, Rapezzi C, Adler Y, Arad M, Basso C, Brucato A et al. Diagnosis and treatment of cardiac amyloidosis: a position statement of the ESC Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2021;42:1554-68.
Dweck MR, Jones C, Joshi NV, Fletcher AM, Richardson H, White A et al. Assessment of valvular calcification and inflammation by positron emission tomography in patients with aortic stenosis. Circulation 2012;125:76-86.
Massera D, Doris MK, Cadet S, Kwiecinski J, Pawade TA, Peeters F et al. Analytical quantification of aortic valve 18F-sodium fluoride PET uptake. J Nucl Cardiol 2020; 27:962-72.
Jenkins WS, Vesey AT, Shah AS, Pawade TA, Chin CW, White AC et al. Valvular (18) F-fluoride and (18)F-fluorodeoxyglucose uptake predict disease progression and clinical outcome in patients with aortic stenosis. J Am Coll Cardiol 2015;66:1200-1.
Dweck MR, Jenkins WS, Vesey AT, Pringle MA, Chin CW, Malley TS et al. 18F-sodium fluoride uptake is a marker of active calcification and disease progression in patients with aortic stenosis. Circ Cardiovasc Imaging 2014;7:371-8.
Zheng KH, Tsimikas S, Pawade T, Kroon J, Jenkins WSA, Doris MK et al. Lipoprotein(a) and oxidized phospholipids promote valve calcification in patients with aortic stenosis. J Am Coll Cardiol 2019;73:2150-62.
Pawade TA, Doris MK, Bing R, White AC, Forsyth L, Evans E et al. Effect of denosumab or alendronic acid on the progression of aortic stenosis: a double-blind randomized controlled trial. Circulation 2021;143:2418-27.
Paolisso P, Beles M, Belmonte M, Gallinoro E, De Colle C, Mileva N et al. Outcomes in patients with moderate and asymptomatic severe aortic stenosis followed up in heart valve clinics. Heart 2023;109:634-42.
Draper J, Subbiah S, Bailey R, Chambers JB. Murmur clinic: validation of a new model for detecting heart valve disease. Heart 2019;105:56-9.
Cohen-Shelly M, Attia ZI, Friedman PA, Ito S, Essayagh BA, Ko W-Y et al. Electrocardiogram screening for aortic valve stenosis using artificial intelligence. Eur Heart J 2021;42:2885-96.
Kwon J-M, Lee SY, Jeon K-H, Lee Y, Kim K-H, Park J et al. Deep learning-based algorithm for detecting aortic stenosis using electrocardiography. J Am Heart Assoc 2020;9: e014717.
Williams MC, Abbas A, Tirr E, Alam S, Nicol E, Shambrook J et al. Reporting incidental coronary, aortic valve and cardiac calcification on non-gated thoracic computed tomography, a consensus statement from the BSCI/BSCCT and BSTI. Br J Radiol 2021;94: 20200894.
Fukui M, Sorajja P, Hashimoto G, Lopes BBC, Stanberry LI, Garcia S et al. Right ventricular dysfunction by computed tomography associates with outcomes in severe aortic stenosis patients undergoing transcatheter aortic valve replacement. J Cardiovasc Comput Tomogr 2022;16:158-65.
Sengupta PP, Shrestha S, Kagiyama N, Hamirani Y, Kulkarni H, Yanamala N et al. A machine-learning framework to identify distinct phenotypes of aortic stenosis severity. JACC Cardiovasc Imaging 2021;14:1707-20.
