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Valvular heart disease: shifting the focus to the myocardium

Marsan, Nina Ajmone; Delgado, Victoria; Shah, Dipan J; Pellikka, Patricia; Bax, Jeroen J; Treibel, Thomas; Cavalcante, Joao L; (2023) Valvular heart disease: shifting the focus to the myocardium. European Heart Journal , 44 (1) pp. 28-40. 10.1093/eurheartj/ehac504. Green open access

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Abstract

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.

Type: Article
Title: Valvular heart disease: shifting the focus to the myocardium
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/eurheartj/ehac504
Publisher version: https://doi.org/10.1093/eurheartj/ehac504
Language: English
Additional information: © The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/).
Keywords: Valular heart disease, Mitral regurgitation, Aortic stenosis, Myocardial function, Myocardial fibrosis, Echocardiography, Magnetic resonance imaging
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
URI: https://discovery.ucl.ac.uk/id/eprint/10162960
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