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Myocardial Fibrosis in Classical Low-Flow, Low-Gradient Severe Aortic Stenosis.

The landscape of aortic stenosis assessment and treatment has undergone a major shift in the last decade. With an aging population, a rising incidence of degenerative aortic valve disease, and enthusiastic global uptake of transcatheter aortic valve replacement, the number of potential candidates for valve intervention is increasing rapidly.1 Although the indication for aortic valve replacement in patients with unequivocal severe, symptomatic aortic stenosis is clear, patients with low-gradient aortic stenosis are commonly encountered and represent a cohort in whom there is often doubt surrounding the appropriate management strategy. Consequently, there is a major need for more sophisticated and nuanced methods to determine who among this group will derive benefit from valve intervention. This is the challenging clinical scenario that Rosa et al2 have investigated using cardiac magnetic resonance (CMR) in the current issue of Circulation: Cardiovascular Imaging.