| TTE |
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Widely accessible, low risk
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First modality of choice in guidelines for assessment of valvular heart disease
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Assesses both systolic and diastolic cardiac function, including ventricular and atrial longitudinal strain
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Assesses pericardial disease and valvular disease
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Assesses cardiac and pulmonary hemodynamics (i.e., ventricular filling pressures and pulmonary arterial pressures)
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Assesses parameters associated with early disease involvement (i.e., global longitudinal strain) and prognosis (i.e., thickness of aorto-mitral curtain)
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Dynamic assessment of valvular function (i.e., stress testing) can be performed
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Superior temporal and spatial resolution compared to other modalities
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Severe calcification may limit accurate assessment of true severity of valvular disease, particularly when the pathology of interest is in the far-field of imaging (i.e., mitral or tricuspid regurgitation)
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Low stroke volume from any cause (i.e., left ventricular systolic or diastolic dysfunction, or concurrent valvular diseases) may confound the assessment of specific valvular diseases and require further testing to delineate severity of specific valvular diseases
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Limited field of view and assessment of surrounding cardiac structures (i.e., lungs or mediastinal structures)
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| TEE |
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Useful when TTE does not provide accurate assessment of disease severity or anatomy (i.e., poor windows or significant shadowing from calcification)
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Useful for greater anatomic definition of valvular pathology
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Useful for preprocedural anatomic assessment of transcathether or surgical suitability
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Superior temporal and spatial resolution compared to other modalities
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Severe calcification may limit accurate assessment of true severity of valvular disease, particularly when the pathology of interest is in the far-field of imaging (i.e., mitral stenosis)
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Low stroke volume from any cause may confound the assessment of specific valvular diseases and require further testing to delineate severity of specific valvular diseases
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Limited imaging windows, narrow field of view and depth of imaging
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| Cardiac MRI |
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Useful in patients with poor TTE windows or discrepant hemodynamic/anatomic assessment and clinical presentation
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Assesses valve anatomy (leaflet number, thickness, structure, mobility, and orifice) and pathology (stenosis and regurgitation)
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Considered the “gold standard” for assessment of cardiac chamber size/volumes/function/shape.
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Assesses anatomy of adjacent cardiac structures (i.e., pulmonary parenchyma, great vessels, mediastinum, etc.).
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Superior temporal resolution to CT
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Can be difficult for patients to tolerate as a modality for serial surveillance imaging
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Dynamic valvular anatomy may be limited by lower temporal and spatial resolution (i.e., less robust for evaluation of mitral and tricuspid valves)
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Special sequencing may be required in the presence of arrhythmias
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Certain pacemakers should not be imaged
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| Cardiac CT |
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Allows for high spatial resolution, three-dimensional, cross-sectional imaging especially in end-systole and end-diastole
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Can be used to assess severity of stenosis (i.e., planimetry, calcium score) with more limited ability to quantify regurgitation
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Assesses ventricular size/mass
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Assesses anatomy of adjacent cardiac structures (i.e., pulmonary parenchyma, great vessels, mediastinum, etc.).
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Assesses coronary pathology
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Superior spatial resolution to MRI
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Large body habitus may limit spatial and temporal resolution
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Involves ionizing radiation
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Involves intravenous contrast agents with nephrotoxicity
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