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Decision Making With Imaging in Asymptomatic Aortic Regurgitation
Zoran B Popović1, Milind Y Desai1, Brian P Griffin1
1Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
JACC. Cardiovascular Imaging
|October 6, 2018
Summary
This review outlines imaging strategies for chronic asymptomatic aortic regurgitation (AR). It details when to use echocardiography, cardiac MRI, or CT to assess AR severity and left ventricular impact, guiding treatment decisions.
Area of Science:
- Cardiology
- Medical Imaging
Background:
- Chronic asymptomatic aortic regurgitation (AR) requires careful evaluation to determine severity and impact on the left ventricle.
- Optimal imaging sequences are crucial for timely diagnosis and management.
Purpose of the Study:
- To review the optimal sequence of multimodality imaging studies for patients with chronic asymptomatic aortic regurgitation (AR).
- To guide clinical decision-making regarding the severity of AR and its effect on left ventricular function.
Main Methods:
- Review of current literature and clinical guidelines on imaging for aortic regurgitation.
- Discussion of the roles of transthoracic echocardiography, cardiovascular magnetic resonance imaging, computed tomography, and transesophageal echocardiography.
- Integration of imaging findings with clinical assessment for treatment planning.
Main Results:
- Transthoracic echocardiography is typically the first-line imaging modality.
- Cardiovascular magnetic resonance imaging is indicated for conflicting or inadequate echocardiographic data or suspected aortopathy in younger patients.
- Computed tomography is recommended for suspected aortopathy in older patients, and transesophageal echocardiography is useful when AR severity or mechanism is unclear or for potential valve repair.
Conclusions:
- The choice of imaging modality depends on the initial assessment of AR severity and left ventricular status.
- Multimodality imaging is essential for accurate diagnosis, risk stratification, and guiding surgical or medical management in chronic asymptomatic AR.
- A clear follow-up plan, discussed with the patient and referring physician, is a critical component of managing chronic AR.
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