Table 1.

Role of imaging techniques in assessing the left ventricle in patients with aortic stenosis

	Advantages	Disadvantages
Echocardiography
LV mass and RWT	Easy to access Useful for classification of LV remodelling Prognostic value	Less accurate and reproducible estimation of LV mass compared with CMR
LV ejection fraction	Mandatory in the decision-making process Established prognostic value in AS	Difficult to measure in patients with suboptimal acoustic window Unable to detect early LV dysfunction
Myocardial velocities, strain ad strain rate (TDI derived)	Early markers of LV dysfunction especially when assessed during or after exercise in asymptomatic patients with AS	Angle dependent Do not reflect global LV function in patients with segmental wall motion abnormalities Partial dependence on the LV afterload
Global longitudinal strain (STE)	Detects global LV dysfunction An early marker or LV decompensation Prognostic value in AS	Inter-vendor variability Lack of clear thresholds to determine LV dysfunction
CMR imaging
LGE	Robust observational prognostic data Qualitative as well as quantitative assessment is of value	Access to CMR Use of gadolinium contrast Unable to detect early, reversible interstitial fibrosis
Native T1	No requirement for gadolinium contrast Global assessment of myocardial tissue composition Early assessment of reversible fibrosis	Access to CMR Lack of established cut-offs for normal and disease states
ECV%	Differentiates between intracellular and extracellular components of myocardium  Dynamic pre-AVR and post-AVR  Early assessment of reversible fibrosis	Access to CMR  Use of gadolinium contrast
Cardiac CT
ECV	Moderate correlation with collagen volume fraction and CMR ECV%  Potentially no requirement for blood sampling (synthetic ECV)  Integration into routine TAVI workflow	Iodinated contrast  Ionising radiation
GLS	Good correlation with CT-derived ejection fraction  Moderate correlation with echocardiography-derived GLS  Potential prognostic relevance	Iodinated contrast  Ionising radiation  Multiphase acquisition  Adequate image quality required

AS, aortic stenosis; AVR, aortic valve replacement; CMR, cardiac magnetic resonance; ECV%, extracellular volume fraction; GLS, global longitudinal strain; LGE, late gadolinium enhancement; LV, left ventricular; RWT, relative wall thickness; STE, speckle tracking echocardiography; TAVI, transcatheter aortic valve implantation; TDI, tissue Doppler imaging.