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Table 1 Role of noninvasive imaging techniques in the assessment of the left ventricle in patients with aortic stenosis

From: The left ventricle in aortic stenosis – imaging assessment and clinical implications

  Advantages Disadvantage/Pitfalls
Echocardiography   
LV geometry parameters (LV mass and RWT) - mandatory for classification of LV remodelling - less accurate and reproducible estimation of LV mass compared to CMR, in particular in patients with large left ventricles
- easy to perform
- demonstrated prognostic value
LV ejection fraction - established prognostic value in patients with AS - overestimates LV systolic function in this setting
- practical implications in the decision making process - difficult to measure in patients with suboptimal acoustic window
MAPSE - widely available and easy to measure - problematic in patients with mitral annular calcification
- useful for the detection of LV longitudinal dysfunction
Peak systolic myocardial velocity (by TDI) - early marker of LV dysfunction especially when assessed during or after exercise in patients with asymptomatic AS - angle dependent
- does not reflect global LV function in pts with segmental wall motion abnormalities
STE derived global longitudinal strain - relatively easy to obtain parameter quantifying longitudinal LV systolic function - requires good image quality and dedicated software
- recent data support its prognostic value in AS patients - lack of standardization on different echo machines (inter-vendor variability)
Parameters reflecting LV diastolic function - allow noninvasive estimation of LV filling pressures - less accurate in patients with associated mitral annular calcification and/or significant mitral regurgitation
- impaired diastolic function is associated with symptomatic status in severe AS
Cardiac magnetic resonance imaging - gold standard assessment of LV volumes, mass and EF as well as myocardial deformation - high cost and limited availability
- allows the detection and quantification of interstitial and focal myocardial fibrosis - demonstrated prognostic value in AS - adverse reactions after i.v. administration of gadolinium-based contrast agents
- results from LGE method vary between different imaging studies (less suitable for folow up studies)
- the equilibrium contrast method for the assessment of diffuse fibrosis is still complex and time-consuming
Computed tomography - allows the assessment of LV volumes and global LV function - exposure to radiation and potential contrast nephrotoxicity
- wider availability when compared to CMR - limited data regarding LV function assessment in AS patients