Assessment of Aortic Valve Disease: Role of Imaging Modalities

Aortic valve disease, which includes aortic valve stenosis (AS) and/or regurgitation (AR), is the most prevalent cardiovascular disease after hypertension and coronary artery disease. Imaging modalities are essential for the staging and management of aortic valve disease. Transthoracic echocardiography (TTE) is the primary imaging modality that is used in clinical practice to assess the aortic valve morphology, the severity of aortic valve disease, and its repercussions on left ventricular (LV) function and pulmonary arterial circulation. Exercise testing and exercise stress echocardiography should be considered in patients with asymptomatic severe aortic valve disease in order to enhance risk stratification and eventually recommend early valve replacement intervention. Three-dimensional (3D) imaging modalities including 3D echocardiography, multidetector computed tomography (MDCT), or cardiac magnetic resonance (CMR) may help to improve the accuracy of the parameters of valve disease severity and LV function. Dobutamine stress echocardiography and, more recently, aortic valve calcium scoring by MDCT have been shown to be useful to confirm stenosis severity in the challenging subsets of patients with low-flow, low-gradient AS. In conclusion, we believe that 3D echocardiography, stress echocardiography, and MDCT are now ready for prime time in clinical practice, and a more systematic but rationale utilization of these modalities should thus be considered in patients with aortic valve disease. Other imaging modalities such as CMR for the assessment of myocardial fibrosis or positron emission tomography for the assessment of valve mineralization activity have been shown to be promising to predict disease progression and outcomes, but further research is necessary before implementation of these modalities into clinical practice.