Valve, Ventricle, and Vessel

Cardiac magnetic resonance (CMR) imaging can be used for the assessment of aortic stenosis in terms of both anatomic and hemodynamic measures of stenosis severity and for evaluation of the left ventricular response to valvular obstruction. In addition, CMR-based assessment of aortic flow patterns has been implicated in poststenotic ascending aortic aneurysm development. In this issue of Circulation: Cardiovascular Imaging , von Knobelsdorff-Brenkenhoff et al1 explore the upstream consequences of postvalvular aortic flow in terms of its association with left ventricular remodeling.1 The study provides arguments for a relationship between left ventricular remodeling and changes in aortic blood flow patterns in patients with aortic stenosis. The results also raise the notion of novel CMR parameters to consider for studies of outcome in, for example, patients with moderate aortic stenosis or for whom incongruent data on stenosis severity are obtained by conventional imaging.See Article by von Knobelsdorff-Brenkenhoff et al In clinical routine, Doppler echocardiography represents an accurate tool for the diagnosis and assessment of aortic stenosis.2 In some cases, however, additional imaging modalities may help to refine the diagnostic and prognostic information. As an example, aortic valve calcification quantification by computed tomography may provide additional support for clinical decisions when stenosis severity measures are incongruent.3 Novel concepts in valve calcification imaging also include nuclear medicine using positron emission tomography to detect valvular uptake of 18F-fluoride, which is a radiotracer of active calcification.4The CMR detection of an excess in myocardial fibrosis, as an early sign …