Detecting native and bioprosthetic aortic valve disease using 18 F-sodium fluoride: Clinical implications
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British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
Received Aug 6, 2020; accepted Sep 26, 2020 doi:10.1007/s12350-020-02411-x
Calcific aortic valve disease is the most common valvular disease and confers significant morbidity and mortality. There are currently no medical therapies that successfully halt or reverse the disease progression, making surgical replacement the only treatment currently available. The majority of patients will receive a bioprosthetic valve, which themselves are prone to degeneration and may also need replaced, adding to the already substantial healthcare burden of aortic stenosis. Echocardiography and computed tomography can identify late-stage manifestations of the disease process affecting native and bioprosthetic aortic valves but cannot detect or quantify early molecular changes. 18F-fluoride positron emission tomography, on the other hand, can non-invasively and sensitively assess disease activity in the valves. The current review outlines the pivotal role this novel molecular imaging technique has played in improving our understanding of native and bioprosthetic aortic valve disease, as well as providing insights into its feasibility as an important future research and clinical tool. Key Words: Aortic stenosis Æ Molecular imaging Æ Positron emission tomography Æ Surgical valve replacement Abbreviations 18 FF-sodium fluoride NaF HALT Hypoattenuated leaflet thickening PET Positron emission tomography CT Computed tomography 18
The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for re-use at meetings and presentations. The authors have also provided an audio summary of the article, which is available to download as ESM, or to listen to via the JNC/ASNC Podcast. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12350-020-02411-x) contains supplementary material, which is available to authorized users. Reprint requests: Alexander J. Fletcher, MD, British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Chancellor’s Building, 49 Little France, EdinburghEH16 4TJ; [email protected] J Nucl Cardiol 1071-3581/$34.00 Copyright Ó 2020 The Author(s)
TAVI TTE TEE
Transcatheter aortic valve implantation Transthoracic echocardiography Transesophageal echocardiography
INTRODUCTION Aortic stenosis affects 1-2% of the general population [65 years old, conferring with it increased mortality.1,2 Current international guidance recommends that the aortic valve should be replacement in those with severe, symptomatic aortic stenosis; a procedure which carries morbidity and significant cost.1,3–5 Replacement with a bioprosthetic valve is recommended in those over 65-70 years old, with mechanical valves preferred in the minority of younger patients.6 Bioprosthetic valves are beneficial in that they do not require the life-long anticoagulation that comes with mechanical valve implantati
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