Novel Biomarkers and Advanced Cardiac Imaging in Aortic Stenosis: Old and New

Figures

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  Figure 1. Left ventricular global longitudinal strain measured via speckle tracking echocardiography in an asymptomatic patient with severe aortic stenosis. The LVEF was normal (64%), and the mean transvalvular gradient was 48 mm Hg. The patient had concentric LV hypertrophy, more prominent in the interventricular septum. An impaired LV GLS (−17.8%) was found in this patient, with more severely reduced values of longitudinal deformation in the basal segments of the interventricular septum. Coronary angiography revealed no significant coronary artery disease. Abbreviations: LV, left ventricle; GLS, global longitudinal strain; LVEF, left ventricular ejection fraction.

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  Figure 2. Left atrial longitudinal deformation in a 71-year-old patient with asymptomatic severe AS, preserved LVEF, and sinus rhythm. We observe in the right panel the LA longitudinal strain curve with a normal mean value of 24.7% (LAƐ). Abbreviations: AS, aortic stenosis; LVEF, left ventricular ejection fraction; LA, left atrium.

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  Figure 3. Left atrial longitudinal deformation in a 73-year-old patient with symptomatic severe AS, preserved LVEF, and sinus rhythm. We observe the LA longitudinal strain curve with a reduced mean value of 13% (LAƐ). Lower values of LA longitudinal strain (LA reservoir function) are observed in the symptomatic patient with severe AS compared to the asymptomatic one (Figure 2). Abbreviations: AS, aortic stenosis; AVC*, aortic valve closure; LVEF, left ventricular ejection fraction; LA, left atrium.

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  Figure 4. Late gadolinium enhancement on cardiac magnetic resonance imaging. The left and right panels represent LV three-chamber and, respectively, short axis CMR views of a patient with symptomatic severe aortic stenosis and moderate LV global systolic dysfunction (LVEF 38%). The LV was severely dilated, with thin walls, except for the IVS, which was hypertrophied. Coronary angiography revealed no significant coronary artery disease. The orange arrow indicates focal, non-ischemic (mid-wall) LGE in the IVS. Abbreviations: LGE, late gadolinium enhancement; CMR, cardiac magnetic resonance; LV, left ventricle; IVS, interventricular septum; LVEF, left ventricular ejection fraction.