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Yet adverse myocardial remodeling—often detected by myocardial strain, volumetric cardiac magnetic resonance, and fibrosis imaging—can occur before guideline thresholds and may be irreversible. Advances in multimodal imaging support earlier risk stratification beyond conventional metrics. Intervention strategies also evolve, including valve repair, valve-sparing root replacement, Ross procedure, and transcatheter aortic valve replacement. This narrative review appraises current evidence and technical limitations shaping earlier intervention.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/asymptomatic-aortic-regurgitation-evolving-imaging-markers-and-contemporary-intervention-strategies/461498/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/asymptomatic-aortic-regurgitation-evolving-imaging-markers-and-contemporary-intervention-strategies/461498.png","ImageObject",300,407,{"name":92,"@type":93},"SANS","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-07","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":24},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is the traditional management approach for asymptomatic aortic regurgitation?","Question",{"text":112,"@type":113},"It has typically been managed conservatively until symptoms appear or left ventricular systolic dysfunction becomes overt.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which imaging findings may reveal risk before guideline thresholds for intervention?",{"text":117,"@type":113},"Myocardial strain, volumetric cardiac magnetic resonance measures, and fibrosis imaging (e.g., LGE and iECV) can identify adverse remodeling earlier than conventional metrics.",{"name":119,"@type":110,"acceptedAnswer":120},"What intervention strategies are evolving for selected high-risk patients with asymptomatic AR?",{"text":121,"@type":113},"Approaches include valve repair, valve-sparing root replacement, the Ross procedure in carefully selected younger patients, and transcatheter aortic valve replacement for selected high-risk cases.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},461498,1791164522,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":24,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":36},962090760505,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Review  \nAsymptomatic Aortic Regurgitation: Evolving Imaging Markers and Contemporary Intervention Strategies  \nChieh-Mei Tsai 1, Kuan-Yu Lai 2, Yu-Chien Su 3, Chi-Han Wu 2, Casper H. H. Tsai 4, Shivam Singh 5 and Li-Tan Yang 3,6, *  \nAcademic Editors: Antonios Halapas and Kent Doi  \nReceived: 4 November 2025  \nRevised: 17 December 2025  \nAccepted: 26 December 2025  \nPublished: 2 January 2026  \nCopyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; [tsai.chieh-mei@mayo.edu](tsai.chieh-mei@mayo.edu)  \n2 Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan; [b07401149@ntu.edu.tw](b07401149@ntu.edu.tw) (K.-Y.L.)  \n3 College of Medicine, National Taiwan University, Taipei 100225, Taiwan  \n4 Department of Surgery, National Taiwan University Hospital, Taipei 100225, Taiwan  \n5 Department of Internal Medicine, Reading Hospital, West Reading, PA 19611, USA  \n6 Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan  \n* Correspondence: [litannyang@yahoo.com.tw](litannyang@yahoo.com.tw)  \nAbstract  \nAsymptomatic aortic regurgitation (AR) has traditionally been managed conservatively until symptom onset or overt left ventricular systolic dysfunction. However, adverse myocardial remodeling—detected by myocardial strain, volumetric cardiac magnetic resonance, and fibrosis imaging—often precedes current guideline thresholds for interventionsand may be irreversible. Advances in multimodal imaging now enable earlier risk stratification beyond conventional metrics. In parallel, intervention strategies are evolving, including valve repair, valve-sparing root replacement, Ross procedure, and transcatheter aortic valve replacement in selected high-risk patients. This narrative review summarizes contemporary advances in imaging and intervention for asymptomatic AR, while critically appraising current evidentiary and technical limitations that constrain earlier intervention. The review is based on a narrative synthesis of the contemporary literature, drawing from recent clinical studies, imaging advances, and guideline documents rather than a systematic evidence search.  \nKeywords: aortic regurgitation; global longitudinal strain; cardiac magnetic resonance; valve repair; Ross procedure; transcatheter aortic valve replacement; multimodal imaging  \n1. Introduction  \nAortic regurgitation (AR) is a prevalent valvular disease whose burden is rising as populations age [1] . In community-dwelling adults ≥65 years, mild AR is observed in approximately 7–14%, while moderate-to-severe AR occurs in ~2–5%[2–4] . Although many patients remain asymptomatic for prolonged periods, longitudinal cohort data shows that one-fifth of patients with Stage B AR progress to Stage C/D hemodynamic severity—defined by worsening quantitative echocardiographic thresholds for at least moderately severe AR—over a median follow-up of four years, and a substantial subset of these progressors subsequently develop symptoms or meet surgical criteria [5,6] . Delayed surgical referral is associated with irreversible myocardial injury and worse postoperative outcomes, underscoring the limitations of relying on symptoms, left ventricular ejection fraction (LVEF), and linear dimensions alone [7–10] .  \nAdvances in multimodal imaging have reshaped contemporary assessment of AR severity and LV remodeling [11] . Three-dimensional (3D) echocardiography improves quantification in eccentric jets, while cardiac magnetic resonance (CMR) offers highly reproducible volumetric assessment and regurgitant quantification [12–16] . Beyond chamber size, CMR tissue characterization with late gadolinium enhancement (LGE) and indexed extracellular volume (iECV) identifies focal and d","cbCaivrX9x0OJSUQ","https://ap.wps.com/l/cbCaivrX9x0OJSUQ","pdf",324000,16,"English","# Abstract\n# Introduction\n# Methods","[{\"question\":\"What is the traditional management approach for asymptomatic aortic regurgitation?\",\"answer\":\"It has typically been managed conservatively until symptoms appear or left ventricular systolic dysfunction becomes overt.\"},{\"question\":\"Which imaging findings may reveal risk before guideline thresholds for intervention?\",\"answer\":\"Myocardial strain, volumetric cardiac magnetic resonance measures, and fibrosis imaging (e.g., LGE and iECV) can identify adverse remodeling earlier than conventional metrics.\"},{\"question\":\"What intervention strategies are evolving for selected high-risk patients with asymptomatic AR?\",\"answer\":\"Approaches include valve repair, valve-sparing root replacement, the Ross procedure in carefully selected younger patients, and transcatheter aortic valve replacement for selected high-risk cases.\"}]","Asymptomatic Aortic Regurgitation - Evolving Imaging Markers and Contemporary Intervention Strategies | PDF",1790761739]