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Fluid Volume Overload and Congestion in Heart Failure: Time to Reconsider Pathophysiology and How Volume Is Assessed Optical frequency-domain imaging findings to predict good stent expansion after rotational atherectomy for severely calcified coronary lesions Therapeutic Options for In-Stent Restenosis Outcomes with intravascular ultrasound-guided stent implantation: a meta-analysis of randomized trials in the era of drug-eluting stents Impact of intravascular ultrasound-guided percutaneous coronary intervention on long-term clinical outcomes in a real world population 2019 ACC Expert Consensus Decision Pathway on Risk Assessment, Management, and Clinical Trajectory of Patients Hospitalized With Heart Failure: A Report of the American College of Cardiology Solution Set Oversight Committee 6-Month Versus 12-Month Dual-Antiplatelet Therapy Following Long Everolimus-Eluting Stent Implantation: The IVUS-XPL Randomized Clinical Trial Positive recommendation for angiotensin receptor/neprilysin inhibitor: First medication approval for heart failure without "reduced ejection fraction" First-in-man evaluation of intravascular optical frequency domain imaging (OFDI) of Terumo: a comparison with intravascular ultrasound and quantitative coronary angiography A Randomized Study of Distal Filter Protection Versus Conventional Treatment During Percutaneous Coronary Intervention in Patients With Attenuated Plaque Identified by Intravascular Ultrasound
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JOURNAL：ACC Article Link

TAVR: Role of Multimodality Imaging

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The following are key points to remember from this state-of-the-art review on transcatheter aortic valve replacement (TAVR) and the role of multimodality imaging in common and complex clinical scenarios:

  1. 1. TAVR has rapidly become an established therapy for patients with symptomatic severe aortic stenosis (AS).
  2. 2. Technological advances and the learning curve have resulted in better procedural results in terms of hemodynamic valve performance and intermediate-term clinical outcomes.
  3. 3. The integration of anatomical and functional information provided by multimodality imaging has improved size selection of TAVR prostheses, permitted better patient selection, and provided new insights in the performance of the TAVR prostheses at follow-up.
  4. 4. The use of 3D imaging techniques (multi-detector row computed tomography [MDCT], cardiac magnetic resonance [CMR], and 3D echocardiography) that permit accurate measurement of the left ventricular outflow tract area by direct planimetry has demonstrated the ability to reclassify severe AS patients into moderate AS by 12% in patients with low-flow, low-gradient severe AS.
  5. 5. Furthermore, the field of TAVR continues to develop and expand the technique to younger patients with lower risk on the one hand, and more complex clinical scenarios, on the other hand, such as degenerated aortic bioprostheses, bicuspid aortic valves, or pure native aortic regurgitation.
  6. 6. The use of both echocardiography and MDCT is key in the diagnosis of patients with severe AS who may benefit from TAVR as well as in the procedural planning and evaluation of the results at follow-up.
  7. 7. The number of patients with bicuspid AS treated with TAVR is increasing and the TAVR results with the use of new generation prostheses are promising.
  8. 8. TAVR in degenerated bioprosthesis has been an important recent breakthrough because re-operation in these individuals is associated with very high mortality.
  9. 9. Patients with native aortic regurgitation are also now being treated with TAVR.
  10. 10. These newer indications for TAVR need careful imaging evaluation of the anatomy of the landing zone to ensure successful anchoring of the TAVR prosthesis and to minimize complications. These new horizons for TAVR are making multimodality imaging critically important for this evolving therapy.

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