Value of each imaging modality in the assessment of both valve disease severity and subsequent myocardial damage according to the different combinations of valvular heart diseases
| . | TTE . | TOE . | Cardiac CT . | Cardiac MR . | Exercise stress echocardiography . | Dobutamine stress echocardiography . |
|---|---|---|---|---|---|---|
| Combination of AS and MR | +++ Severity of valve disease. Mechanism of MR. Myocardial damage. | ++ Mechanism of the MR. Feasibility/planning and guidance of surgical or transcatheter interventions mainly for MR. | ++ Severity of AS (calcium scoring). Planning for transcatheter procedures for both AS and MR (replacement). | + Myocardial damage including assessment of myocardial fibrosis. Severity of MR. | + Severity of MR in selected cases. | + Severity of AS in case of low-flow (stroke volume <35 mL/m2) low-gradient (mean pressure gradient <40 mmHg) And depressed LVEF. |
| Combination of AS and TR | +++ Severity of valve disease. Myocardial damage, with special focus on the right chambers. | + Feasibility/planning and guidance of transcatheter intervention of the TR | ++ Planning for transcatheter procedures for the AS and for some of the TR (annuloplasty or replacement) | + Myocardial damage including assessment of myocardial fibrosis. Severity of TR. | + Severity of AS in case of low-flow (stroke volume <35 mL/m2) low-gradient (mean pressure gradient < 40 mmHg)and depressed LVEF | |
| Combination of MR and AR | +++ Severity of the valve diseases and mechanism. Myocardial damage. Aorta dimension assessment. | ++ Mechanism and severity of AR and MR. Feasibility/planning and guidance of transcatheter procedures mainly for MR. | + Planning for transcatheter valve replacement. | ++ Severity of valve disease. Myocardial damage including myocardial fibrosis assessment. Aortic dimensions. | + Severity of MR in selected cases. | Combination of MR and AR |
| Combination of MR and TR | +++ Severity of valve disease. Mechanism of MR and TR. Myocardial damage. | ++ Mechanism of the MR and TR. Feasibility/planning and guidance of surgical or transcatheter interventions both for TR and MR. | + Planning for transcatheter tricuspid valve annuloplasty or replacement or mitral valve replacement. | ++ Severity of TR and MR. Myocardial damage including assessment of myocardial fibrosis. | + Severity of MR in selected cases | |
| Combination of MS and AS | +++ Quantification of valve diseases and myocardial damage. Determine the aetiology of MS and suitability of the mitral valve for PBMV. | ++ Determine the aetiology of MS and suitability of the mitral valve for PBMV. Ensure the absence of left atrial appendage thrombus. | ++ Severity of AS (calcium scoring). Assessing the calcifications of the mitral valve. | + Possibly to assess the severity of MS by exercise (valve area and pulmonary pressures). | ||
| Combination of MS and AR | +++ Quantification of valve diseases (direct planimetry and vena contracta width preferred) and myocardial damage. Determine the aetiology of MS and suitability of the mitral valve for PBMV. | +++ More accurate assessment of valve disease severity. Determine the aetiology of MS and suitability of the mitral valve for PBMV. | ++ Assessing the calcifications of the mitral valve | ++ Quantification of AR severity. Myocardial damage. | + Possibly to assess the severity of MS by exercise (valve area and pulmonary pressures). |
| . | TTE . | TOE . | Cardiac CT . | Cardiac MR . | Exercise stress echocardiography . | Dobutamine stress echocardiography . |
|---|---|---|---|---|---|---|
| Combination of AS and MR | +++ Severity of valve disease. Mechanism of MR. Myocardial damage. | ++ Mechanism of the MR. Feasibility/planning and guidance of surgical or transcatheter interventions mainly for MR. | ++ Severity of AS (calcium scoring). Planning for transcatheter procedures for both AS and MR (replacement). | + Myocardial damage including assessment of myocardial fibrosis. Severity of MR. | + Severity of MR in selected cases. | + Severity of AS in case of low-flow (stroke volume <35 mL/m2) low-gradient (mean pressure gradient <40 mmHg) And depressed LVEF. |
| Combination of AS and TR | +++ Severity of valve disease. Myocardial damage, with special focus on the right chambers. | + Feasibility/planning and guidance of transcatheter intervention of the TR | ++ Planning for transcatheter procedures for the AS and for some of the TR (annuloplasty or replacement) | + Myocardial damage including assessment of myocardial fibrosis. Severity of TR. | + Severity of AS in case of low-flow (stroke volume <35 mL/m2) low-gradient (mean pressure gradient < 40 mmHg)and depressed LVEF | |
| Combination of MR and AR | +++ Severity of the valve diseases and mechanism. Myocardial damage. Aorta dimension assessment. | ++ Mechanism and severity of AR and MR. Feasibility/planning and guidance of transcatheter procedures mainly for MR. | + Planning for transcatheter valve replacement. | ++ Severity of valve disease. Myocardial damage including myocardial fibrosis assessment. Aortic dimensions. | + Severity of MR in selected cases. | Combination of MR and AR |
| Combination of MR and TR | +++ Severity of valve disease. Mechanism of MR and TR. Myocardial damage. | ++ Mechanism of the MR and TR. Feasibility/planning and guidance of surgical or transcatheter interventions both for TR and MR. | + Planning for transcatheter tricuspid valve annuloplasty or replacement or mitral valve replacement. | ++ Severity of TR and MR. Myocardial damage including assessment of myocardial fibrosis. | + Severity of MR in selected cases | |
| Combination of MS and AS | +++ Quantification of valve diseases and myocardial damage. Determine the aetiology of MS and suitability of the mitral valve for PBMV. | ++ Determine the aetiology of MS and suitability of the mitral valve for PBMV. Ensure the absence of left atrial appendage thrombus. | ++ Severity of AS (calcium scoring). Assessing the calcifications of the mitral valve. | + Possibly to assess the severity of MS by exercise (valve area and pulmonary pressures). | ||
| Combination of MS and AR | +++ Quantification of valve diseases (direct planimetry and vena contracta width preferred) and myocardial damage. Determine the aetiology of MS and suitability of the mitral valve for PBMV. | +++ More accurate assessment of valve disease severity. Determine the aetiology of MS and suitability of the mitral valve for PBMV. | ++ Assessing the calcifications of the mitral valve | ++ Quantification of AR severity. Myocardial damage. | + Possibly to assess the severity of MS by exercise (valve area and pulmonary pressures). |
The role of each imaging modality for the assessment of the feasibility and the planning of surgical and transcatheter interventions is also highlighted.
Value of each imaging modality in the assessment of both valve disease severity and subsequent myocardial damage according to the different combinations of valvular heart diseases
| . | TTE . | TOE . | Cardiac CT . | Cardiac MR . | Exercise stress echocardiography . | Dobutamine stress echocardiography . |
|---|---|---|---|---|---|---|
| Combination of AS and MR | +++ Severity of valve disease. Mechanism of MR. Myocardial damage. | ++ Mechanism of the MR. Feasibility/planning and guidance of surgical or transcatheter interventions mainly for MR. | ++ Severity of AS (calcium scoring). Planning for transcatheter procedures for both AS and MR (replacement). | + Myocardial damage including assessment of myocardial fibrosis. Severity of MR. | + Severity of MR in selected cases. | + Severity of AS in case of low-flow (stroke volume <35 mL/m2) low-gradient (mean pressure gradient <40 mmHg) And depressed LVEF. |
| Combination of AS and TR | +++ Severity of valve disease. Myocardial damage, with special focus on the right chambers. | + Feasibility/planning and guidance of transcatheter intervention of the TR | ++ Planning for transcatheter procedures for the AS and for some of the TR (annuloplasty or replacement) | + Myocardial damage including assessment of myocardial fibrosis. Severity of TR. | + Severity of AS in case of low-flow (stroke volume <35 mL/m2) low-gradient (mean pressure gradient < 40 mmHg)and depressed LVEF | |
| Combination of MR and AR | +++ Severity of the valve diseases and mechanism. Myocardial damage. Aorta dimension assessment. | ++ Mechanism and severity of AR and MR. Feasibility/planning and guidance of transcatheter procedures mainly for MR. | + Planning for transcatheter valve replacement. | ++ Severity of valve disease. Myocardial damage including myocardial fibrosis assessment. Aortic dimensions. | + Severity of MR in selected cases. | Combination of MR and AR |
| Combination of MR and TR | +++ Severity of valve disease. Mechanism of MR and TR. Myocardial damage. | ++ Mechanism of the MR and TR. Feasibility/planning and guidance of surgical or transcatheter interventions both for TR and MR. | + Planning for transcatheter tricuspid valve annuloplasty or replacement or mitral valve replacement. | ++ Severity of TR and MR. Myocardial damage including assessment of myocardial fibrosis. | + Severity of MR in selected cases | |
| Combination of MS and AS | +++ Quantification of valve diseases and myocardial damage. Determine the aetiology of MS and suitability of the mitral valve for PBMV. | ++ Determine the aetiology of MS and suitability of the mitral valve for PBMV. Ensure the absence of left atrial appendage thrombus. | ++ Severity of AS (calcium scoring). Assessing the calcifications of the mitral valve. | + Possibly to assess the severity of MS by exercise (valve area and pulmonary pressures). | ||
| Combination of MS and AR | +++ Quantification of valve diseases (direct planimetry and vena contracta width preferred) and myocardial damage. Determine the aetiology of MS and suitability of the mitral valve for PBMV. | +++ More accurate assessment of valve disease severity. Determine the aetiology of MS and suitability of the mitral valve for PBMV. | ++ Assessing the calcifications of the mitral valve | ++ Quantification of AR severity. Myocardial damage. | + Possibly to assess the severity of MS by exercise (valve area and pulmonary pressures). |
| . | TTE . | TOE . | Cardiac CT . | Cardiac MR . | Exercise stress echocardiography . | Dobutamine stress echocardiography . |
|---|---|---|---|---|---|---|
| Combination of AS and MR | +++ Severity of valve disease. Mechanism of MR. Myocardial damage. | ++ Mechanism of the MR. Feasibility/planning and guidance of surgical or transcatheter interventions mainly for MR. | ++ Severity of AS (calcium scoring). Planning for transcatheter procedures for both AS and MR (replacement). | + Myocardial damage including assessment of myocardial fibrosis. Severity of MR. | + Severity of MR in selected cases. | + Severity of AS in case of low-flow (stroke volume <35 mL/m2) low-gradient (mean pressure gradient <40 mmHg) And depressed LVEF. |
| Combination of AS and TR | +++ Severity of valve disease. Myocardial damage, with special focus on the right chambers. | + Feasibility/planning and guidance of transcatheter intervention of the TR | ++ Planning for transcatheter procedures for the AS and for some of the TR (annuloplasty or replacement) | + Myocardial damage including assessment of myocardial fibrosis. Severity of TR. | + Severity of AS in case of low-flow (stroke volume <35 mL/m2) low-gradient (mean pressure gradient < 40 mmHg)and depressed LVEF | |
| Combination of MR and AR | +++ Severity of the valve diseases and mechanism. Myocardial damage. Aorta dimension assessment. | ++ Mechanism and severity of AR and MR. Feasibility/planning and guidance of transcatheter procedures mainly for MR. | + Planning for transcatheter valve replacement. | ++ Severity of valve disease. Myocardial damage including myocardial fibrosis assessment. Aortic dimensions. | + Severity of MR in selected cases. | Combination of MR and AR |
| Combination of MR and TR | +++ Severity of valve disease. Mechanism of MR and TR. Myocardial damage. | ++ Mechanism of the MR and TR. Feasibility/planning and guidance of surgical or transcatheter interventions both for TR and MR. | + Planning for transcatheter tricuspid valve annuloplasty or replacement or mitral valve replacement. | ++ Severity of TR and MR. Myocardial damage including assessment of myocardial fibrosis. | + Severity of MR in selected cases | |
| Combination of MS and AS | +++ Quantification of valve diseases and myocardial damage. Determine the aetiology of MS and suitability of the mitral valve for PBMV. | ++ Determine the aetiology of MS and suitability of the mitral valve for PBMV. Ensure the absence of left atrial appendage thrombus. | ++ Severity of AS (calcium scoring). Assessing the calcifications of the mitral valve. | + Possibly to assess the severity of MS by exercise (valve area and pulmonary pressures). | ||
| Combination of MS and AR | +++ Quantification of valve diseases (direct planimetry and vena contracta width preferred) and myocardial damage. Determine the aetiology of MS and suitability of the mitral valve for PBMV. | +++ More accurate assessment of valve disease severity. Determine the aetiology of MS and suitability of the mitral valve for PBMV. | ++ Assessing the calcifications of the mitral valve | ++ Quantification of AR severity. Myocardial damage. | + Possibly to assess the severity of MS by exercise (valve area and pulmonary pressures). |
The role of each imaging modality for the assessment of the feasibility and the planning of surgical and transcatheter interventions is also highlighted.
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