Valve, Ventricle, and Vessel

Cardiac magnetic resonance (CMR) imaging can be used for the assessment of aortic stenosis in terms of both anatomic and hemodynamic measures of stenosis severity and for evaluation of the left ventricular response to valvular obstruction. In addition, CMR-based assessment of aortic flow patterns has been implicated in poststenotic ascending aortic aneurysm development. In this issue of Circulation: Cardiovascular Imaging, von Knobelsdorff-Brenkenhoff et al explore the upstream consequences of postvalvular aortic flow in terms of its association with left ventricular remodeling. The study provides arguments for a relationship between left ventricular remodeling and changes in aortic blood flow patterns in patients with aortic stenosis. The results also raise the notion of novel CMR parameters to consider for studies of outcome in, for example, patients with moderate aortic stenosis or for whom incongruent data on stenosis severity are obtained by conventional imaging.