Author + information
- Received January 10, 2018
- Revision received May 7, 2018
- Accepted May 18, 2018
- Published online October 1, 2018.
- Zoran B. Popović, MD, PhD∗ (, )
- Milind Y. Desai, MD and
- Brian P. Griffin, MD
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Zoran B. Popović, Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, Ohio 44195.
The authors review the optimal sequence of multimodality imaging studies in patients with chronic asymptomatic aortic regurgitation (AR). The initial questions in evaluating such patients are: 1) is AR severe; and 2) does it significantly impact the left ventricle? Although transthoracic echocardiography is usually able to answer these questions, a cardiovascular magnetic resonance imaging study might be necessary if the data from echocardiography are conflicting or inadequate. If AR is severe and the left ventricle is severely dilated, surgery is indicated. If AR is severe but the left ventricle is not significantly impacted, echocardiographic exercise testing might unmask symptoms. If aortopathy is suspected, cardiovascular magnetic resonance (in younger patients) or computed tomography (in older patients) is necessary. In cases where AR severity or mechanism are unclear and no additional tests are possible, or if there is a potential for aortic valve repair, transesophageal echocardiography is appropriate. Finally, it is good practice to define a follow-up plan with the patient and referring physician, with an explanation as to what can be expected in the future.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 10, 2018.
- Revision received May 7, 2018.
- Accepted May 18, 2018.
- 2018 American College of Cardiology Foundation
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