PDF(Pubmed)
Abstract：
Aortic stenosis (AS) is the most prevalent degenerative valvular disease in western countries. Transthoracic echocardiography (TTE) is considered, nowadays, to be the main imaging technique for the work-up of AS due to high availability, safety, low cost, and excellent capacity to evaluate aortic valve (AV) morphology and function. Despite the diagnosis of AS being considered straightforward for a very long time, based on high gradients and reduced aortic valve area (AVA), many patients with AS represent a real dilemma for cardiologist. On the one hand, the acoustic window may be inadequate and the TTE limited in some cases. On the other hand, a growing body of evidence shows that patients with low gradients (due to systolic dysfunction, concentric hypertrophy or coexistence of another valve disease such as mitral stenosis or regurgitation) may develop severe AS (low-flow low-gradient severe AS) with a similar or even worse prognosis. The use of complementary imaging techniques such as transesophageal echocardiography (TEE), multidetector computed tomography (MDTC), or cardiac magnetic resonance (CMR) plays a key role in such scenarios. The aim of this review is to summarize the diagnostic challenges associated with patients with AS and the advantages of a comprehensive multimodality cardiac imaging (MCI) approach to reach a precise grading of the disease, a crucial factor to warrant an adequate management of patients.
摘要：
主动脉瓣狭窄（AS）是西方国家最常见的退行性瓣膜疾病。考虑经胸超声心动图（TTE），如今,由于高可用性，成为AS后处理的主要成像技术，安全,低成本,以及评估主动脉瓣（AV）形态和功能的出色能力。尽管AS的诊断在很长一段时间内被认为是简单的，基于高梯度和减少的主动脉瓣面积（AVA），许多AS患者对心脏病专家来说是一个真正的困境。一方面,在一些情况下,声学窗口可能是不足的并且TTE有限。另一方面,越来越多的证据表明，低梯度患者(由于收缩功能障碍，同心性肥大或与其他瓣膜疾病如二尖瓣狭窄或反流共存)可能会发展为重度AS(低流量低梯度重度AS),预后相似甚至更差.使用互补成像技术，如经食管超声心动图（TEE），多探测器计算机断层扫描(MDTC)，或心脏磁共振（CMR）在此类场景中起着关键作用。这篇综述的目的是总结与AS患者相关的诊断挑战，以及综合多模态心脏成像（MCI）方法的优势，以达到疾病的精确分级。这是保证对患者进行适当管理的关键因素。
