Table 1 Role of noninvasive imaging techniques in the assessment of the left ventricle in patients with aortic stenosis
From: The left ventricle in aortic stenosis – imaging assessment and clinical implications
Advantages | Disadvantage/Pitfalls | |
|---|---|---|
Echocardiography | ||
LV geometry parameters (LV mass and RWT) | - mandatory for classification of LV remodelling | - less accurate and reproducible estimation of LV mass compared to CMR, in particular in patients with large left ventricles |
- easy to perform | ||
- demonstrated prognostic value | ||
LV ejection fraction | - established prognostic value in patients with AS | - overestimates LV systolic function in this setting |
- practical implications in the decision making process | - difficult to measure in patients with suboptimal acoustic window | |
MAPSE | - widely available and easy to measure | - problematic in patients with mitral annular calcification |
- useful for the detection of LV longitudinal dysfunction | ||
Peak systolic myocardial velocity (by TDI) | - early marker of LV dysfunction especially when assessed during or after exercise in patients with asymptomatic AS | - angle dependent |
- does not reflect global LV function in pts with segmental wall motion abnormalities | ||
STE derived global longitudinal strain | - relatively easy to obtain parameter quantifying longitudinal LV systolic function | - requires good image quality and dedicated software |
- recent data support its prognostic value in AS patients | - lack of standardization on different echo machines (inter-vendor variability) | |
Parameters reflecting LV diastolic function | - allow noninvasive estimation of LV filling pressures | - less accurate in patients with associated mitral annular calcification and/or significant mitral regurgitation |
- impaired diastolic function is associated with symptomatic status in severe AS | ||
Cardiac magnetic resonance imaging | - gold standard assessment of LV volumes, mass and EF as well as myocardial deformation | - high cost and limited availability |
- allows the detection and quantification of interstitial and focal myocardial fibrosis - demonstrated prognostic value in AS | - adverse reactions after i.v. administration of gadolinium-based contrast agents | |
- results from LGE method vary between different imaging studies (less suitable for folow up studies) | ||
- the equilibrium contrast method for the assessment of diffuse fibrosis is still complex and time-consuming | ||
Computed tomography | - allows the assessment of LV volumes and global LV function | - exposure to radiation and potential contrast nephrotoxicity |
- wider availability when compared to CMR | - limited data regarding LV function assessment in AS patients |