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evaluation of LV volumes and LVEF than 2D echocardiography, and are useful in borderline cases (Figure 4).45,209 Strain imaging can be helpful in identifying subclinical LV dysfunction209–211 and can therefore influence the optimal timing of intervention. Reduced longitudinal strain and contractile reserve at stress echocardiography,212 elevated biomarkers (BNP),213,214 and the presence of myocardial fibrosis detected by CMR need to be integrated in the decision-making process, even if not entirely validated yet.209 Given its close relationship with AV function, accurate measurements of the aortic diameter are required at all levels: the annulus, sinuses of Valsalva, sinotubular junction, and ascending aorta.8,215,216
The largest diameter is used to indicate the specific aortic phenotype: root phenotype, ascending phenotypes, and extended or mixed forms (see Supplementary data online, Figure S1).8 The mechanism of AR and aortic diameters determine suitability for AV sparing or repair.217,218
≥
≥
≥ ≥ >
Figure 4 Imaging assessment of patients with aortic regurgitation. AR, aortic regurgitation; CCT, cardiac computed tomography; CMR, cardiac magnetic resonance; EDV, end-diastolic velocity; EROA, effective regurgitant orifice area; LV, left ventricle/left ventricular; LVEF, left ventricular ejection fraction; LVESDi, left ventricular end-systolic diameter indexed to body surface area; LVESVi, left ventricular end-systolic volume indexed to body surface area; LVOT, left ventricular outflow tract; PHT, pressure half-time; RF, regurgitant fraction; RVol; regurgitant volume. aSee Recommendation Table 3 for specific cut-offs.
ESC Guidelines 4659
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