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The Impact of Coronary Physiology on Contemporary Clinical Decision Making Pulmonary Hypertension in Heart Failure: Pathophysiology, Pathobiology, and Emerging Clinical Perspectives Comparison of Coronary Computed Tomography Angiography, Fractional Flow Reserve, and Perfusion Imaging for Ischemia Diagnosis Impact of low tissue backscattering by optical coherence tomography on endothelial function after drug-eluting stent implantation Randomized trial of simple versus complex drug-eluting stenting for bifurcation lesions: the British Bifurcation Coronary Study: old, new, and evolving strategies Haemodynamic definitions and updated clinical classification of pulmonary hypertension Long-term outcomes after treatment of bare-metal stent restenosis with paclitaxel-coated balloon catheters or everolimus-eluting stents: 3-year follow-up of the TIS clinical study Angiography Alone Versus Angiography Plus Optical Coherence Tomography to Guide Percutaneous Coronary Intervention: Outcomes From the Pan-London PCI Cohort Prognostic Implications of Plaque Characteristics and Stenosis Severity in Patients With Coronary Artery Disease Percutaneous Coronary Intervention For Bifurcation Coronary Lesions.The 15th Consensus Document from the European Bifurcation Club
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Review ArticleVolume 13, Issue 2 Part 1, February 2020

JOURNAL：JACC Cardiovasc Imaging. Article Link

Management of Asymptomatic Severe Aortic Stenosis: Evolving Concepts in Timing of Valve Replacement

BR Lindman, MR Dweck, P Lancellotti et al. Keywords: aortic stenosis; biomarkers; cardiac magnetic resonance imaging; echocardiography

ABSTRACT

New insights into the pathophysiology and natural history of patients with aortic stenosis, coupled with advances in diagnostic imaging and the dramatic evolution of transcatheter aortic valve replacement, are fueling intense interest in the management of asymptomatic patients with severe aortic stenosis. An intervention that is less invasive than surgery could conceivably justify pre-emptive transcatheter aortic valve replacement in subsets of patients, rather than waiting for the emergence of early symptoms to trigger valve intervention. Clinical experience has shown that symptoms can be challenging to ascertain in many sedentary, deconditioned, and/or elderly patients. Evolving data based on imaging and biomarker evidence of adverse ventricular remodeling, hypertrophy, inflammation, or fibrosis may radically transform existing clinical decision paradigms. Clinical trials currently enrolling asymptomatic patients have the potential to change practice patterns and lower the threshold for intervention.
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