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A Randomized Study of Distal Filter Protection Versus Conventional Treatment During Percutaneous Coronary Intervention in Patients With Attenuated Plaque Identified by Intravascular Ultrasound Frailty Is Intertwined With Heart Failure: Mechanisms, Prevalence, Prognosis, Assessment, and Management Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents: the assessment of dual antiplatelet therapy with drug-eluting stents (ADAPT-DES) study Assessment of coronary atherosclerosis by IVUS and IVUS-based imaging modalities: progression and regression studies, tissue composition and beyond Comparison of intravascular ultrasound guided versus angiography guided drug eluting stent implantation: a systematic review and meta-analysis Surgery Does Not Improve Survival in Patients With Isolated Severe Tricuspid Regurgitation Phenomapping for Novel Classification of Heart Failure With Preserved Ejection Fraction Temporal Trends in Inpatient Use of Intravascular Imaging Among Patients Undergoing Percutaneous Coronary Intervention in the United States Derivation, Validation, and Prognostic Utility of a Prediction Rule for Nonresponse to Clopidogrel: The ABCD-GENE Score Cardiovascular biomarkers in patients with acute decompensated heart failure randomized to sacubitril-valsartan or enalapril in the PIONEER-HF trial

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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.