Contemporary Multimodality Imaging Evaluation in Native Aortic Stenosis

Abstract

Aortic stenosis (AS) is the most prevalent valvular heart disease in developed nations, with increasing incidence driven by population aging. Early and accurate diagnosis is crucial, as timely intervention significantly improves outcomes. Contemporary imaging plays a central role in the assessment of AS, enabling precise evaluation of valve anatomy, disease severity, left ventricular remodeling, and procedural planning. Transthoracic echocardiography remains the first-line modality, providing essential hemodynamic and structural data. However, limitations in cases of low-flow states, discordant grading, and atypical presentations necessitate adjunctive tools. Transesophageal echocardiography enhances visualization of valve morphology and annular dimensions, particularly for pre-procedural assessment. Cardiac computed tomography (CT) has emerged as a cornerstone in transcatheter aortic valve replacement (TAVR) planning, offering unparalleled spatial resolution for annular sizing, coronary height measurement, and vascular access evaluation. Meanwhile, cardiac magnetic resonance (CMR) provides robust quantification of ventricular volumes, fibrosis, and myocardial strain, serving as a prognostic marker in asymptomatic and borderline cases. The integration of multimodality imaging offers a comprehensive framework, addressing diagnostic ambiguities and guiding individualized management strategies. This review highlights current advances, clinical applications, and future directions in multimodality imaging for AS, emphasizing its pivotal role in optimizing patient selection, risk stratification, and procedural outcomes.

Keywords

Aortic stenosis / Echocardiogram / Cardiac computed tomography

Author Contributions

Conceptualization T.K.M.W. and A.D.A., Original draft preparation A.D.A., K.H., E.H., A.A., writing A.D.A., K.H., A.A., A.G., V.M., R.J.R., Y.O., J.E.R., A.F., visualization J.E.R., K.H., supervision T.K.M.W.

Ethics Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Funding

This article received no funding.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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