Thornton, George D;
McKenna, Michael;
Bennett, Jonathan;
Hughes, Alun;
González, Arantxa;
Khanji, Mohammed Y;
Cavalcante, João L;
... Treibel, Thomas A; + view all
(2025)
Myocardial Remodelling in Aortic Regurgitation: Time to Think Beyond Volumes and Function?
European Heart Journal - Cardiovascular Imaging
, Article jeaf264. 10.1093/ehjci/jeaf264.
(In press).
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Abstract
Current guideline criteria for surgical intervention in chronic aortic regurgitation (AR) rely on fixed thresholds of left ventricular size and ejection fraction, but these metrics may overlook early myocardial injury and under-appreciate patient heterogeneity, particularly in women and older adults. Cardiovascular magnetic resonance (CMR) offers robust quantification of regurgitant volume, three-dimensional ventricular volumes, and both focal (late gadolinium enhancement) and diffuse (T1-mapping-derived extracellular volume) fibrosis. Observational studies have linked CMR-detected fibrosis to worse clinical outcomes and less favourable reverse remodelling after valve intervention, suggesting that fibrosis may mark the transition from compensated overload to irreversible myocardial damage. In this narrative review, we appraise the limitations of current guidelines, compare echocardiographic and CMR approaches to AR assessment, and summarize the evidence supporting myocardial fibrosis as a potential imaging biomarker for risk stratification. We discuss how integrating CMR-derived fibrosis metrics with volumetric and functional data could personalize timing of aortic valve intervention. While prospective studies are needed to validate fibrosis-guided decision-making, this evolving paradigm holds promise for earlier identification of patients at risk for irreversible myocardial injury, with the ultimate goal of preserving ventricular function and improving long-term outcomes.
| Type: | Article |
|---|---|
| Title: | Myocardial Remodelling in Aortic Regurgitation: Time to Think Beyond Volumes and Function? |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/ehjci/jeaf264 |
| Publisher version: | https://doi.org/10.1093/ehjci/jeaf264 |
| Language: | English |
| Additional information: | This work is licensed under a Creative Commons License. The images or other third-party material in this article are included in the Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ |
| Keywords: | MRI, Valvular heart disease, aortic regurgitation, aortic valve disease |
| 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 UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Population Science and Experimental Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10213312 |
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