Non-invasive imaging for structural heart disease

Summary

Structural heart disease includes a heterogeneous group of non-coronary heart diseases where catheter-based interventions have become a feasible therapeutic option in the last decade. Accurate preprocedural evaluation and optimal guidance are crucial to optimise the results and minimise the complications of these procedures. Fluoroscopic and haemodynamic assessments have been the key to guiding percutaneous treatment of structural heart disease. However, the wide spectrum of structural abnormalities and the poor soft-tissue resolution of cine-angiography demand the use of complementary imaging techniques with higher spatial resolution to characterise better the structural lesion and select the most appropriate therapeutic approach. Non-invasive imaging techniques such as echocardiography, magnetic resonance imaging (MRI) and multi-detector row computed tomography (MDCT) are currently considered the foremost imaging tools to diagnose structural heart disease and play a central role in patient selection for percutaneous interventions. In addition, fusion of these imaging technologies (MRI and MDCT) with live x-ray is a promising tool to guide the procedures. Furthermore, novel techniques such as videodensitometric quantitative angiography has been introduced as a potential tool for guidance of aortic and mitral interventions 1, 21. Modolo, R, et al. Quantitative aortography assessment of aortic regurgitation. EuroIntervention. 2020 16(9): pe738-e756. Link