Low-dose dobutamine stress cardiovascular magnetic resonance imaging to assess aortic stenosis severity in left ventricular systolic dysfunction and severe mitral annular calcification.

We present a case of a patient with symptomatic heart failure and chronic kidney disease in which severe mitral valve calcification prevented accurate assessment of aortic stenosis (AS) severity using conventional guideline-directed imaging modalities. We used a novel technique of low dose dobutamine stress cardiovascular magnetic resonance (LD-dCMR) imaging to elucidate and confirm severe AS, allowing the patient to subsequently proceed to have a successful transcatheter aortic valve implantation. To our knowledge, this is the first reported case in the literature base of LD-dCMR confirming severe AS in left ventricular systolic dysfunction where conventional imaging modalities were limited by dystrophic cardiac calcification.