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Calcification of Vascular Smooth Muscle Cells and Imaging of Aortic Calcification and Inflammation
Published on: May 31, 2016
Novel Biomarkers and Advanced Cardiac Imaging in Aortic Stenosis: Old and New
Anca Drăgan1, Anca Doina Mateescu2
1Department of Cardiovascular Anaesthesiology and Intensive Care, Emergency Institute for Cardiovascular Diseases "Prof Dr C C Iliescu", 258 Fundeni Road, 022328 Bucharest, Romania.
Insights
New imaging techniques and biomarkers offer improved risk assessment for aortic stenosis (AS) patients. These methods provide objective measures of left ventricular (LV) decompensation, aiding in treatment decisions beyond subjective symptoms and ejection fraction.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Biomarkers
Background:
- Current aortic stenosis (AS) assessment relies on subjective symptoms and left ventricular ejection fraction (LVEF), which are limited in detecting left ventricular (LV) decompensation.
- Advanced imaging and novel biomarkers are emerging as crucial tools for evaluating cardiac structure and function in AS.
- Understanding the transition from compensatory left ventricular hypertrophy to dysfunction is key in managing AS progression.
Purpose of the Study:
- To review novel non-invasive imaging parameters and biomarkers for risk stratification and prognosis in aortic stenosis.
- To discuss the role of these parameters in optimizing the timing for aortic valve replacement.
- To explore biomarkers associated with myocardial wall stress, fibrosis, and myocyte death in AS.
Main Methods:
- Review of current literature on advanced cardiac imaging techniques, including cardiac magnetic resonance for myocardial fibrosis assessment.
- Analysis of emerging biomarkers reflecting LV decompensation, myocardial wall stress, fibrosis, and myocyte death.
- Evaluation of left ventricular global longitudinal strain for risk stratification in asymptomatic severe AS patients.
Main Results:
- Left ventricular global longitudinal strain is a valuable predictor for risk stratification in asymptomatic severe AS with preserved LVEF.
- Cardiac magnetic resonance assessment of myocardial fibrosis provides significant prognostic information in AS.
- Biomarkers offer objective measures of LV decompensation, complementing traditional assessment methods.
Conclusions:
- Novel imaging parameters and biomarkers show promise in improving the assessment and management of aortic stenosis.
- These tools may help optimize the timing of aortic valve replacement by providing objective measures of LV status.
- Further randomized clinical trial data are needed to establish the routine clinical utility of these advanced methods in AS practice.
Abstract:
Currently, the symptomatic status and left ventricular ejection fraction (LVEF) play a crucial role in aortic stenosis (AS) assessment. However, the symptoms are often subjective, and LVEF is not a sensitive marker of left ventricle (LV) decompensation. Over the past years, the cardiac structure and function research on AS has increased due to advanced imaging modalities and potential therapies. New imaging parameters emerged as predictors of disease progression in AS. LV global longitudinal strain has proved useful for risk stratification in asymptomatic severe AS patients with preserved LVEF. The assessment of myocardial fibrosis by cardiac magnetic resonance is the most studied application and offers prognostic information on AS. Moreover, the usage of biomarkers in AS as objective measures of LV decompensation has recently gained more interest. The present review focuses on the transition from compensatory LV hypertrophy (H) to LV dysfunction and the biomarkers associated with myocardial wall stress, fibrosis, and myocyte death. Moreover, we discuss the potential impact of non-invasive imaging parameters for optimizing the timing of aortic valve replacement and provide insight into novel biomarkers for possible prognostic use in AS. However, data from randomized clinical trials are necessary to define their utility in daily practice.
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