# Asymptomatic Aortic Regurgitation: Evolving Imaging Markers and Contemporary Intervention Strategies

## TL;DR

This review discusses new imaging techniques and treatment options for asymptomatic aortic regurgitation, focusing on early detection and evolving interventions.

## Contribution

The paper highlights novel imaging markers and intervention strategies for asymptomatic aortic regurgitation that go beyond traditional guidelines.

## Key findings

- Adverse myocardial remodeling can occur before traditional intervention thresholds.
- Multimodal imaging allows for earlier risk stratification in asymptomatic aortic regurgitation.
- New intervention strategies include valve repair and transcatheter aortic valve replacement.

## Abstract

Asymptomatic 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 interventions and 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.