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Multimodality Imaging Markers of Adverse Myocardial Remodeling in Aortic Stenosis

Thomas A Treibel1, Sveeta Badiani2, Guy Lloyd1

  • 1Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.

JACC. Cardiovascular Imaging
|August 10, 2019
PubMed

Insights

Aortic stenosis (AS) causes cardiac remodeling that impacts outcomes after valve replacement. Multimodality imaging assesses these changes, guiding improved patient care and intervention timing for better results.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Cardiovascular Disease

Background:

  • Aortic stenosis (AS) induces significant left ventricular remodeling, including hypertrophy, fibrosis, and other cardiac alterations.
  • These structural changes, and their reversibility (reverse remodeling), critically influence outcomes following aortic valve replacement (AVR).
  • Adaptive vs. maladaptive cardiac remodeling in AS can lead to residual risks post-intervention.

Purpose of the Study:

  • To review the role of multimodality imaging in evaluating myocardial remodeling in aortic stenosis.
  • To assess how imaging characterizes hypertrophy, fibrosis, and microvascular changes before and after AVR.
  • To highlight potential improvements in AS care and outcomes through advanced imaging assessment.

Main Methods:

  • Review of current literature on multimodality cardiovascular imaging techniques.
  • Analysis of how imaging modalities assess myocardial hypertrophy and its components in AS.
  • Evaluation of imaging's utility in predicting reversibility of cardiac changes post-intervention.

Main Results:

  • Multimodality imaging is crucial for assessing the extent and nature of myocardial remodeling in AS.
  • Imaging can differentiate between adaptive and maladaptive cardiac changes, informing prognosis.
  • Assessment of cardiac structure and function beyond the aortic valve is essential for optimizing AVR outcomes.

Conclusions:

  • Comprehensive imaging assessment of myocardial remodeling in AS is vital for patient management.
  • Understanding the reversibility of cardiac changes post-AVR can mitigate residual risks.
  • Integrating advanced imaging insights can lead to improved timing and outcomes for AS interventions.

Keywords:
aortic stenosisaortic valve replacementmyocardial fibrosismyocardial hypertrophy

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