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Special Issue "Diagnosis of Aortic Stenosis"

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A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 5310

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Special Issue Editors

Prof. Dr. Maria Angela Losi

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Guest Editor

Department of Advanced Medical Sciences, Universita' Federico II, Naples, Italy
Interests: hypertrophic cardiomyopathy; aortic stenosis; echocardiography; heart failure; arterial hypertension
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Anna Franzone

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Guest Editor

Department of Advanced Medical Sciences, Università Federico II, Naples, Italy
Interests: transcatheter aortic valve implantation; valve heart disease; aortic stenosis

Special Issue Information

Dear Colleagues,

Calcific aortic stenosis (AS) is the most frequent heart valve disease in developed countries. It is characterized by the progressive fibro-calcific remodelling of valve leaflets that evolve into severe stenosis over years. AS is the third most frequent cardiovascular disease after coronary artery disease and systemic arterial hypertension, with a prevalence of 0.4% in the general population and 1.7% in the population >65 years old.

This Special Issue aims to provide a comprehensive representation of diagnostic tools on aortic stenosis by gathering contributions covering all aspects related to this field. The Special Issue will address fundamental questions on finding a definitive diagnosis on AS presence and degree, and will explore the most recent trials and meta-analysis trials on the associated valvular disease in patients with AS.

Prof. Dr. Maria Angela Losi
Prof. Dr. Anna Franzone
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

aortic stenosis
echocardiography
cardiac computer tomography
cardiac nuclear magnetic resonance

Published Papers (6 papers)

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Review

Open AccessReview

Echocardiographic Evaluation of Aortic Stenosis: A Comprehensive Review

Maddalena Immobile Molaro

Giulia Sgherzi

Domenico Simone Castiello

Fiorenzo Simonetti

Ciro Santoro

Mario Enrico Canonico

and

Diagnostics 2023, 13(15), 2527; https://doi.org/10.3390/diagnostics13152527 - 29 Jul 2023

Viewed by 1310

Abstract

Echocardiography represents the most important diagnostic tool in the evaluation of aortic stenosis. The echocardiographic assessment of its severity should always be performed through a standardized and stepwise approach in order to achieve a comprehensive evaluation. The latest technical innovations in the field of echocardiography have improved diagnostic accuracy, guaranteeing a better and more detailed evaluation of aortic valve anatomy. An early diagnosis is of utmost importance since it shortens treatment delays and improves patient outcomes. Echocardiography plays a key role also in the evaluation of all the structural changes related to aortic stenosis. Detailed evaluation of subtle and subclinical changes in left ventricle function has a prognostic significance: scientific efforts have been addressed to identify the most accurate global longitudinal strain cut-off value able to predict adverse outcomes. Moreover, in recent years the role of artificial intelligence is increasingly emerging as a promising tool able to assist cardiologists in aortic stenosis screening and diagnosis, especially by reducing the rate of aortic stenosis misdiagnosis. Full article

(This article belongs to the Special Issue Diagnosis of Aortic Stenosis)

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Open AccessReview

Pitfalls and Tips in the Assessment of Aortic Stenosis by Transthoracic Echocardiography

and

Diagnostics 2023, 13(14), 2414; https://doi.org/10.3390/diagnostics13142414 - 19 Jul 2023

Viewed by 546

Abstract

Aortic stenosis (AS) is a valvular heart disease that significantly contributes to cardiovascular morbidity and mortality worldwide. The condition is characterized by calcification and thickening of the aortic valve leaflets, resulting in a narrowed orifice and increased pressure gradient across the valve. AS typically progresses from a subclinical phase known as aortic sclerosis, where valve calcification occurs without a transvalvular gradient, to a more advanced stage marked by a triad of symptoms: heart failure, syncope, and angina. Echocardiography plays a crucial role in the diagnosis and evaluation of AS, serving as the primary non-invasive imaging modality. However, to minimize misdiagnoses, it is crucial to adhere to a standardized protocol for acquiring echocardiographic images. This is because, despite continuous advances in echocardiographic technology, diagnostic errors still occur during the evaluation of AS, particularly in classifying its severity and hemodynamic characteristics. This review focuses on providing guidance for the imager during the echocardiographic assessment of AS. Firstly, the review will report on how the echo machine should be set to improve image quality and reduce noise and artifacts. Thereafter, the review will report specific emphasis on accurate measurements of left ventricular outflow tract diameter, aortic valve morphology and movement, as well as aortic and left ventricular outflow tract velocities. By considering these key factors, clinicians can ensure consistency and accuracy in the evaluation of AS using echocardiography. Full article

(This article belongs to the Special Issue Diagnosis of Aortic Stenosis)

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Open AccessReview

Beyond Aortic Stenosis: Addressing the Challenges of Multivalvular Disease Assessment

and

Diagnostics 2023, 13(12), 2102; https://doi.org/10.3390/diagnostics13122102 - 17 Jun 2023

Viewed by 971

Abstract

Aortic stenosis (AS) can often coexist with other valvular diseases or be combined with aortic regurgitation (AR), leading to unique pathophysiological conditions. The combination of affected valves can vary widely, resulting in a lack of standardized diagnostic or therapeutic approaches. Echocardiography is crucial in assessing patients with valvular heart disease (VHD), but careful consideration of the hemodynamic interactions between combined valvular defects is necessary. This is important as it may affect the reliability of commonly used echocardiographic parameters, making the diagnosis challenging. Therefore, a multimodality imaging approach, including computed tomography or cardiac magnetic resonance, is often not just beneficial but crucial. It represents the future of diagnostics in this intricate field due to its unprecedented capacity to quantify and comprehend valvular pathology. The absence of definitive data and guidelines for the therapeutic management of AS in the context of multiple valve lesions makes this condition particularly challenging. As a result, an individualized, case-by-case approach is necessary, guided primarily by the recommendations for the predominant valve lesion. This review aims to summarize the pathophysiology of AS in the context of multiple and mixed valve disease, with a focus on the hemodynamic implications, diagnostic challenges, and therapeutic options. Full article

(This article belongs to the Special Issue Diagnosis of Aortic Stenosis)

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Open AccessReview

Imaging of Bioprosthetic Valve Dysfunction after Transcatheter Aortic Valve Implantation

and

Diagnostics 2023, 13(11), 1908; https://doi.org/10.3390/diagnostics13111908 - 29 May 2023

Viewed by 721

Abstract

Transcatheter aortic valve implantation (TAVI) has become the standard of care in elderly high-risk patients with symptomatic severe aortic stenosis. Recently, TAVI has been increasingly performed in younger-, intermediate- and lower-risk populations, which underlines the need to investigate the long-term durability of bioprosthetic aortic valves. However, diagnosing bioprosthetic valve dysfunction after TAVI is challenging and only limited evidence-based criteria exist to guide therapy. Bioprosthetic valve dysfunction encompasses structural valve deterioration (SVD) resulting from degenerative changes in the valve structure and function, non-SVD resulting from intrinsic paravalvular regurgitation or patient–prosthesis mismatch, valve thrombosis, and infective endocarditis. Overlapping phenotypes, confluent pathologies, and their shared end-stage bioprosthetic valve failure complicate the differentiation of these entities. In this review, we focus on the contemporary and future roles, advantages, and limitations of imaging modalities such as echocardiography, cardiac computed tomography angiography, cardiac magnetic resonance imaging, and positron emission tomography to monitor the integrity of transcatheter heart valves. Full article

(This article belongs to the Special Issue Diagnosis of Aortic Stenosis)

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Open AccessReview

ABCDEG Stress Echocardiography in Aortic Stenosis

Quirino Ciampi

Lauro Cortigiani

Maria Rivadeneira Ruiz

Andrea Barbieri

Fiore Manganelli

Fabio Mori

Maria Grazia D’Alfonso

Francesca Bursi

and

Bruno Villari

Diagnostics 2023, 13(10), 1727; https://doi.org/10.3390/diagnostics13101727 - 12 May 2023

Viewed by 694

Abstract

Rest and stress echocardiography (SE) plays a pivotal role in the evaluation of valvular heart disease. The use of SE is recommended in valvular heart disease when there is a mismatch between resting transthoracic echocardiography findings and symptoms. In aortic stenosis (AS), rest echocardiographic analysis is a stepwise approach that begins with the evaluation of aortic valve morphology and proceeds to the measurement of the transvalvular aortic gradient and aortic valve area (AVA) using continuity equations or planimetry. The presence of the following three criteria suggests severe AS: AVA < 1.0 cm², a peak velocity > 4.0 m/s, or a mean gradient > 40 mmHg. However, in approximately one in three cases, we can observe a discordant AVA < 1 cm² with a peak velocity < 4.0 m/s or a mean gradient <40 mmHg. This is due to reduced transvalvular flow associated with LV systolic dysfunction (LVEF < 50%) defined as “classical” low-flow low-gradient (LFLG) AS or normal LVEF “paradoxical” LFLG AS. SE has an established role in evaluating LV contractile reserve (CR) patients with reduced LVEF. In classical LFLG AS, LV CR distinguished pseudo-severe AS from truly severe AS. Some observational data suggest that long-term prognosis in asymptomatic severe AS may not be as favorable as previously thought, offering a window of opportunity for intervention prior to the onset of symptoms. Therefore, guidelines recommend evaluating asymptomatic AS with exercise stress in physically active patients, particularly those younger than 70 years, and symptomatic classical LFLG severe AS with low-dose dobutamine SE. A comprehensive SE assessment includes evaluating valve function (gradients), the global systolic function of the LV, and pulmonary congestion. This assessment integrates considerations of blood pressure response, chronotropic reserve, and symptoms. StressEcho 2030 is a prospective, large-scale study that employs a comprehensive protocol (ABCDEG) to analyze the clinical and echocardiographic phenotypes of AS, capturing various vulnerability sources which support stress echo-driven treatment strategies. Full article

(This article belongs to the Special Issue Diagnosis of Aortic Stenosis)

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Open AccessReview

Is There Still a Role for Invasive Assessment of Aortic Gradient?

Domenico Angellotti

Maddalena Immobile Molaro

Fiorenzo Simonetti

Federica Ilardi

Domenico Simone Castiello

and

Diagnostics 2023, 13(10), 1698; https://doi.org/10.3390/diagnostics13101698 - 11 May 2023

Viewed by 710

Abstract

Advances in technology and imaging have expanded the range of tools for diagnosing aortic stenosis (AS). The accurate assessment of aortic valve area and mean pressure gradient is crucial to determine which patients are appropriate candidates for aortic valve replacement. Nowadays, these values can be obtained noninvasively or invasively, with similar results. Contrariwise, in the past, cardiac catheterization played a major role in the evaluation of AS severity. In this review, we will discuss the historical role of the invasive assessment of AS. Moreover, we will specifically focus on tips and tricks for properly performing cardiac catheterization in patients with AS. We will also elucidate the role of invasive methods in current clinical practice and their additional value to the information provided through non-invasive techniques. Full article

(This article belongs to the Special Issue Diagnosis of Aortic Stenosis)

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