Valvular heart disease: shifting the focus to the myocardium
Por:
Marsan, NA, Delgado, V, Shah, DJ, Pellikka, P, Bax, JJ, Treibel, T and Cavalcante, JL
Publicada:
1 ene 2023
Ahead of Print:
1 sep 2022
Resumen:
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.
Filiaciones:
Marsan, NA:
Leiden Univ, Dept Cardiol, Med Ctr, Binusdreef 2, NL-2300 RC Leiden, Netherlands
:
Leiden Univ, Dept Cardiol, Med Ctr, Binusdreef 2, NL-2300 RC Leiden, Netherlands
Germans Trias I Pujol Hosp, Dept Cardiol, Carretera Canyet S-N, Barcelona 08916, Spain
Shah, DJ:
Houston Methodist DeBakey Heart & Vasc Ctr, Weill Cornell Med Coll, Div Cardiovasc Imaging, 6565 Fannin St, Houston, TX 77030 USA
Pellikka, P:
Mayo Clin, Dept Cardiovasc Med, 200 First St SW, Rochester, MN 55905 USA
Bax, JJ:
Leiden Univ, Dept Cardiol, Med Ctr, Binusdreef 2, NL-2300 RC Leiden, Netherlands
Treibel, T:
Barts Heart Ctr, Dept Cardiol, London EC1A 7BE, England
UCL, London EC1A 7BE, England
Cavalcante, JL:
Abbott NW Hosp, Dept Cardiol, Minneapolis Heart Inst, 800 E 28th St, Minneapolis, MN 55407 USA
hybrid, Green Published
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