TY - JOUR
T1 - Valvular heart disease
T2 - shifting the focus to the myocardium
AU - Marsan, Nina Ajmone
AU - Delgado, Victoria
AU - Shah, Dipan J.
AU - Pellikka, Patricia
AU - Bax, Jeroen J.
AU - Treibel, Thomas
AU - Cavalcante, João L.
N1 - Publisher Copyright:
© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Adverse cardiac remodelling is the main determinant of patient prognosis in degenerative valvular heart disease (VHD). However, to give an indication for valvular intervention, current guidelines include parameters of cardiac chamber dilatation or function which are subject to variability, do not directly reflect myocardial structural changes, and, more importantly, seem to be not sensitive enough in depicting early signs of myocardial dysfunction before irreversible myocardial damage has occurred. To avoid irreversible myocardial dysfunction, novel biomarkers are advocated to help refining indications for intervention and risk stratification. Advanced echocardiographic modalities, including strain analysis, and magnetic resonance imaging have shown to be promising in providing new tools to depict the important switch from adaptive to maladaptive myocardial changes in response to severe VHD. This review, therefore, summarizes the current available evidence on the role of these new imaging biomarkers in degenerative VHD, aiming at shifting the clinical perspective from a valve-centred to a myocardium-focused approach for patient management and therapeutic decision-making.
AB - Adverse cardiac remodelling is the main determinant of patient prognosis in degenerative valvular heart disease (VHD). However, to give an indication for valvular intervention, current guidelines include parameters of cardiac chamber dilatation or function which are subject to variability, do not directly reflect myocardial structural changes, and, more importantly, seem to be not sensitive enough in depicting early signs of myocardial dysfunction before irreversible myocardial damage has occurred. To avoid irreversible myocardial dysfunction, novel biomarkers are advocated to help refining indications for intervention and risk stratification. Advanced echocardiographic modalities, including strain analysis, and magnetic resonance imaging have shown to be promising in providing new tools to depict the important switch from adaptive to maladaptive myocardial changes in response to severe VHD. This review, therefore, summarizes the current available evidence on the role of these new imaging biomarkers in degenerative VHD, aiming at shifting the clinical perspective from a valve-centred to a myocardium-focused approach for patient management and therapeutic decision-making.
KW - Aortic stenosis
KW - Echocardiography
KW - Magnetic resonance imaging
KW - Mitral regurgitation
KW - Myocardial fibrosis
KW - Myocardial function
KW - Valular heart disease
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U2 - 10.1093/eurheartj/ehac504
DO - 10.1093/eurheartj/ehac504
M3 - Review article
C2 - 36167923
AN - SCOPUS:85145425324
SN - 0195-668X
VL - 44
SP - 28
EP - 40
JO - European heart journal
JF - European heart journal
IS - 1
ER -