Valvular heart disease: shifting the focus to the myocardium

Nina Ajmone Marsan, Victoria Delgado, Dipan J. Shah, Patricia Pellikka, Jeroen J. Bax, Thomas Treibel, João L. Cavalcante

Research output: Contribution to journalReview articlepeer-review

33 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)28-40
Number of pages13
JournalEuropean heart journal
Issue number1
Early online dateSep 28 2022
StatePublished - Jan 1 2023


  • Biomarkers
  • Cardiomyopathies/pathology
  • Heart
  • Heart Valve Diseases
  • Humans
  • Mitral Valve Insufficiency
  • Myocardium/pathology
  • Aortic stenosis
  • Myocardial function
  • Myocardial fibrosis
  • Echocardiography
  • Magnetic resonance imaging
  • Mitral regurgitation
  • Valular heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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