A Comparison of Advanced Imaging Techniques in Aortic Stenosis
A Comparison of Advanced Imaging Techniques in Aortic Stenosis
In patients with aortic stenosis the valve through which blood is pumped out of the main
 heart chamber is narrowed. This results in heart muscle working harder to open the valve so
 blood can circulate around the body. The muscle adapts to the increased pressure load to
 maintain efficiency. This can cause long-term muscle damage. To predict when this
 deterioration will require a valve replacement is difficult and untimely operation exposes
 patients to unnecessary risk.

 We aim to compare all validated techniques looking at different aspects of heart muscle
 strain in these patients. These will be a blood sample measuring a specific hormone (BNP) and
 enzyme (Troponin), a nuclear scan to assess nerve activation, an MRI identifying scarring and
 an exercise echocardiogram that measures heart muscle response and pressure changes across
 the valve. Tests will be performed at recruitment and either after one year or after valve
 replacement, which ever comes first.

 In comparing these different imaging techniques we aim to identify patients who will benefit
 from an early operation, those whose muscle is likely to recover back to normal and which
 patients it is safe to wait longer for the surgery, avoiding unnecessary risk.

 The results of the study will benefit patients as it will help doctors more accurately assess
 the timing of valve surgery and improve their prediction of long term heart muscle recovery.
 It may also increase convenience in clinical management by reducing unnecessary tests and
 hospital trips. This would translate into cost savings for the NHS.
Inclusion Criteria:

 (Group A)

 -  Asymptomatic patients with moderate to severe Aortic Stenosis

 -  Ejection fraction greater than 50%

 -  Not yet being considered for valve surgery

 (Group B)

 -  Severe Aortic Stenosis (as per ESC guidelines)

 -  Listed for immediate aortic valve replacement

 Exclusion Criteria: (Group A and B)

 -  Inability to provide informed consent

 -  Concurrent primary valve lesions greater than mild (as defined by ESC criteria)

 -  Previous myocardial infarction (regional wall motion abnormality on resting echo)

 -  Cardiomyopathy

 -  Congenital heart disease

 -  Previous cardiac surgery

 -  Renal failure (CKD stage 3, eGFR >30ml/min/1.73m2)

 -  Pregnancy, risk of pregnancy, breast feeding