Evidence-based Assessment and Management of Valvular Heart Disease
Valvular Heart Disease Assessment & Care in Brisbane
Valvular heart disease refers to any disorder affecting the heart’s four valves: mitral, aortic, tricuspid, and pulmonary. Dysfunction may be due to stenosis (narrowing), regurgitation (leakage), or a combination of both, leading to altered blood flow, chamber remodelling, and potentially heart failure if left unmanaged.
Dr. Jonathan Sen is a specialist cardiologist and cardio-oncologist who provides specialised evaluation and care for patients with valvular heart disease. His expertise includes conditions such as aortic stenosis, mitral regurgitation, mitral stenosis, and tricuspid valve disorders. With a strong commitment to evidence-based practice and patient-centred care, Dr. Sen helps individuals navigate complex decisions about monitoring and treatment.
Assessment and Monitoring of Valvular Heart Disease
Assessment of valvular heart disease typically involves a detailed history, physical examination, and comprehensive cardiac imaging. Dr. Sen uses advanced echocardiographic techniques to characterise valve function and assess how dysfunction affects the heart’s structure and performance. All findings are discussed in detail to help patients understand their condition and available management options.
The assessment process includes:
Comprehensive echocardiographic assessment – A tailored valvular protocol ensures accurate measurement of valve gradients, effective orifice area, regurgitant volumes, and effects on cardiac chambers.
Exercise stress testing or advanced echocardiography – When appropriate, functional capacity is evaluated to uncover symptoms that may not be apparent at rest and to guide timing of valve intervention.
Integration of clinical and imaging data – Decision-making for valvular heart disease combines the full clinical picture with precise imaging measurements rather than relying on isolated metrics.
Collaboration with interventional specialists – When intervention is indicated for valvular heart disease, Dr. Sen works closely with interventional cardiologists and cardiac surgeons to coordinate referral and ensure seamless continuity of care.
Valve Intervention might not be immediately necessary
While there are situations when urgent valve intervention is required, not every valve abnormality that is detected requires urgent surgery or catheter‑based repair/replacement. Close observation, often termed “watchful waiting” or “conservative management”, might be the safest and most appropriate course when symptoms are absent or minimal, and where imaging shows stable valvular heart disease.
A conservative approach for valvular heart disease allows us to:
Monitor disease progression with periodic imaging and regular clinical review.
Avoid unnecessary procedural risks when the benefit is uncertain.
Tailor timing of any future intervention to the moment it is truly advantageous for the individual’s overall health and quality of life.
Optimal timing of intervention, the ideal management strategy and personalised cardiovascular care is an area of active research worldwide. Decisions about whether to proceed with an intervention are always made collaboratively after reviewing the full clinical picture and discussing the patient’s personal goals and preferences.
Aortic Stenosis: Research and Expertise
Aortic stenosis is one of the most common valve problems, particularly in older adults. It occurs when the aortic valve becomes narrowed, restricting blood flow from the heart to the rest of the body. Careful assessment is crucial for determining appropriate management strategies.
Dr. Sen’s PhD research focused specifically on aortic stenosis. He developed and validated prognostic phenotypes using machine learning and clinical data, work that has been published in multiple high-impact journals including JACC: Cardiovascular Imaging. This research examines how different patient characteristics influence outcomes and helps inform treatment decisions for those living with this condition.
Key areas of his recent research include:
Mitral asterisk as a high-risk phenotype within moderate aortic stenosis
Accepted to publish in JACC: Cardiovascular Imaging (2026), this editorial by Dr. Sen examines the clinical significance of concomitant mitral regurgitation in patients with moderate aortic stenosis.
Clinical risk scores for cardiac death or heart failure hospitalisation in moderate aortic stenosis
Published in Echo Research and Practice (2026), this work developed and validated a practical risk stratification tool for moderate aortic stenosis. The score supports shared decision-making between clinicians and patients regarding the potential need for intervention, helps guide how frequently follow-up should occur based on individual risk, and assists in identifying suitable candidates for future randomised trials within this clinically diverse population.
Definition and validation of prognostic phenotypes in moderate aortic stenosis
Published in JACC: Cardiovascular Imaging (2025), this landmark study established distinct patient subgroups with differing risks of adverse outcomes, helping clinicians better stratify patients requiring closer monitoring versus conservative management.
Prognostication and Interventional Guidance Using Acceleration-Ejection Time Ratio in Undifferentiated Paradoxical Low-Flow Low-Gradient Aortic Stenosis
Co-first authored work published in JACC: Cardiovascular Imaging (2024), demonstrating that a simple Doppler-derived ratio (AT:ET) can identify true severe disease and guide decisions about aortic valve intervention in this diagnostically challenging condition.
Prognostic Signals from Moderate Valve Disease in Big Data: An Artefact of DICOM Structured Reporting?
Published in the Journal of the American Society of Echocardiography (2023), this study showed that apparent associations between moderate valve disease and adverse outcomes in large datasets may be artefacts of automated DICOM structured reporting, underscoring the need for data quality validation in big-data valve research.
Prognostic Implications of Severe Low-Flow Low-Gradient Aortic Stenosis Defined by Stroke Volume Index and Transvalvular Flow Rate
Published in JACC: Cardiovascular Imaging (2021), this study demonstrated that both stroke volume index and transvalvular flow rate independently identify high-risk patients who may benefit from earlier aortic valve replacement regardless of ejection fraction.
Dr. Sen brings this research knowledge directly into his clinical practice. His approach balances the use of modern interventions with the prudence of careful observation, ensuring that each individual receives the right treatment at the right time.
Dr. Sen’s extensive publication record in valvular heart disease means he stays at the forefront of emerging evidence, bringing the latest insights to every consultation. Whether you require surveillance for mild valve disease, structured monitoring for moderate stenosis, or preparation for potential intervention, you can expect thorough evaluation and clear communication throughout your care journey.
If you have been diagnosed with valvular heart disease or have concerns about a heart murmur or suspected valve problem, contact the clinic today to arrange a consultation with Dr. Sen.