title: Aortic Stenosis, a Left Ventricular Disease: Insights from Advanced Imaging.
abstract: Aortic stenosis (AS) is the most common primary valve disorder in the elderly with an increasing prevalence. It is increasingly clear that it is also a disease of the left ventricle (LV) rather than purely the aortic valve. The transition from left ventricular hypertrophy to fibrosis results in the eventual adverse effects on systolic and diastolic function. Appropriate selection of patients for aortic valve intervention is crucial, and current guidelines recommend aortic valve replacement in severe AS with symptoms or in asymptomatic patients with left ventricular ejection fraction (LVEF) <50 %. LVEF is not a sensitive marker and there are other parameters used in multimodality imaging techniques, including longitudinal strain, exercise stress echo and cardiac MRI that may assist in detecting subclinical and subtle LV dysfunction. These findings offer potentially better ways to evaluate patients, time surgery, predict recovery and potentially offer targets for specific therapies. This article outlines the pathophysiology behind the LV response to aortic stenosis and the role of advanced multimodality imaging in describing it.
authors.affiliation: Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.
authors.forename: Sveeta
authors.initials: S
authors.lastname: Badiani
authors.affiliation: Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.|Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex, BN21 2UD, UK.
authors.forename: Jet
authors.initials: J
authors.lastname: van Zalen
authors.affiliation: Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.|Institute of Cardiovascular Science, University College London, London, EC1A 7BE, UK.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Treibel
authors.affiliation: Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.|Institute of Cardiovascular Science, University College London, London, EC1A 7BE, UK.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Bhattacharyya
authors.affiliation: Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.|Institute of Cardiovascular Science, University College London, London, EC1A 7BE, UK.
authors.forename: James C
authors.initials: JC
authors.lastname: Moon
authors.affiliation: Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK. guy.lloyd@bartshealth.nhs.uk.|Institute of Cardiovascular Science, University College London, London, EC1A 7BE, UK. guy.lloyd@bartshealth.nhs.uk.|Institute of Advanced Cardiovascular Imaging, Queens Mary's University of London, West Smithfield, London, EC1A 7BE, UK. guy.lloyd@bartshealth.nhs.uk.
authors.forename: Guy
authors.initials: G
authors.lastname: Lloyd
mesh_terms: D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D004452:Echocardiography; D006350:Heart Valve Prosthesis; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D013318:Stroke Volume; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement; D016277:Ventricular Function, Left
keywords: Aortic stenosis; Cardiac magnetic resonance; Echocardiography; Left ventricle; Myocardial fibrosis