Review
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Aug 26, 2018; 10(8): 62-73
Published online Aug 26, 2018. doi: 10.4330/wjc.v10.i8.62
Newer echocardiographic techniques for aortic-valve imaging: Clinical aids today, clinical practice tomorrow
Nidhish Tiwari, Kavisha Patel
Nidhish Tiwari, Kavisha Patel, Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, United States
Author contributions: Tiwari N contributed designed and drafted the paper outline; Patel K performed the literature search; both contributed equally to writing the manuscript; Tiwari N edited the final version.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected byan in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nidhish Tiwari, MD, FACC, FASE, FACP, Assistant Professor, Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, 1400 Pelham Parkway South, Bronx, NY 10461, United States. nidhish.tiwari@nychhc.org
Telephone: +1-646-4087740 Fax: +1-888-5882920
Received: April 10, 2018
Peer-review started: April 10, 2018
First decision: May 16, 2018
Revised: May 22, 2018
Accepted: June 30, 2018
Article in press: June 30, 2018
Published online: August 26, 2018
Processing time: 139 Days and 14.1 Hours
Abstract

Increasing life expectancy is expected to lead to a corresponding increase in the prevalence of aortic valve disease (AVD). Further, the number of indications for transcatheter aortic valve replacement (TAVR) as a treatment option for AVD is expanding, with a growing role for echocardiography in its management. In this review we summarize the current literature on some newer echocardiographic modalities and the parameters they generate, with a particular focus on their prognostic and clinical value beyond conventional methods in the management of aortic stenosis, TAVR, and aortic regurgitation. Speckle tracking and 3D echocardiography are now increasingly being used in the management of AVD. For instance, global longitudinal strain, the best-studied speckle tracking echocardiographic parameter, can detect subtle subclinical cardiac dysfunction in patients with AVD that is not apparent using traditional echocardiographic techniques. The emerging technique of 3D full volume color Doppler echocardiography provides more accurate measurement of the severity of aortic regurgitation than 2D-proximal isovelocity surface area. These novel techniques are promising for evaluating and risk stratifying patients to optimize surgical interventions, predict recovery, and improve clinical outcomes.

Keywords: Aortic stenosis; Aortic regurgitation; Speckle tracking echocardiography; Strain; Torsion; Transcatheter aortic valve replacement; Low flow low gradient aortic stenosis; 3D echocardiography

Core tip: Reduced strain is now established for early diagnosis, prognosis, and risk stratification, predicting post-op recovery and showing associations with mortality. Decreased global longitudinal strain (GLS) is a robust parameter to diagnose subclinical left ventricular dysfunction before the left ventricular ejection fraction deteriorates and the patient develops symptoms. GLS also correlates with disease severity and helps to identify patients with excess risk of cardiovascular events and death who are likely to benefit from earlier surgical intervention. The high accuracy and reproducibly of 3D echocardiography has made the precise assessment of volume and AR possible and, therefore, the early recognition of its severity.