Can the assessment of myocardial fibrosis using cardiac magnetic resonance improve the timing of aortic valve replacement in patients with aortic stenosis?
Cardiac magnetic resonance imaging of myocardial fibrosis (LGE and T1 mapping) provides an objective marker of left ventricular decompensation that could optimize the timing of aortic valve replacement in aortic stenosis.
Aortic stenosis is characterized both by progressive valve narrowing and the left ventricular remodeling response that ensues. The only effective treatment is aortic valve replacement, which is usually recommended in patients with severe stenosis and evidence of left ventricular decompensation. At present, left ventricular decompensation is most frequently identified by the development of typical symptoms or a marked reduction in left ventricular ejection fraction 1 mapping techniques. There is a substantial body of observational data in this field, but there is now a need for randomized clinical trials of myocardial imaging in aortic stenosis to optimize patient management. This review will discuss the role that myocardial fibrosis plays in aortic stenosis, how it can be imaged, and how these approaches might be used to track myocardial health and improve the timing of aortic valve replacement.
Bing et al. (Fri,) studied this question.
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