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Special Issue "Clinical Advances in Cardiothoracic Surgery: Towards Individualized Treatment of Valvular Heart Disease"

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Department of Cardiovascular Surgery, University Heart & Vascular Center Hamburg, 20251 Hamburg, Germany
Interests: aortic valve repair; endovascular surgery; aortic valve surgery; aortic surgery; bicuspid aortic valve; mitral valve repair; minimal- invasive valve surgery; minimally invasive cardiac surgery
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Dear Colleagues,

The development of individualized treatment strategies in patients with valvular heart disease (VHD) is progressing. New knowledge from research suggests that in the case of severe valvular heart disease, early intervention to prevent the development and progression of valvular cardiomyopathy improves the long-term outcomes, in particular when reconstructive, native, valve-preserving treatment strategies are implemented. Evidence regarding such a treatment strategy is already available for patients with degenerative mitral valve disease and aortic valve stenosis. However, in the case of aortic regurgitation, secondary mitral regurgitation and tricuspid regurgitation, appropriate evidence for early treatment is still lacking. However, the incremental use of circulating and imaging biomarkers in cardiovascular medicine to optimize decision-making processes for timely interventions may significantly impact the future treatment of the abovementioned valvular heart diseases. In general, this Special Issue aims to specifically address the field of evolving circulating and imaging biomarkers intended to improve the decision-making process in the treatment of valvular heart disease. Although not exclusively, the focus is on the less appreciated valvular lesions—aortic regurgitation, secondary mitral regurgitation and tricuspid valve disease. In summary, the primary aim of this Special Issue is to increase clinicians’ awareness of an as-yet poorly explored area of early decision making in patients with aortic regurgitation, secondary mitral regurgitation and tricuspid valve disease based on the novel currently available biomarkers to guide timely valvular intervention.

Prof. Dr. Evaldas Girdauskas
Guest Editor

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Keywords

biomarkers
valvular heart disease
mitral regurgitation
aortic regurgitation
tricuspid valve disease
cardiovascular MRI

Published Papers (2 papers)

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Research

Open AccessArticle

Valvular Cardiomyopathy in Aortic Valve Regurgitation Correlates with Myocardial Fibrosis

Hermann Reichenspurner

Torsten Christ

and

Evaldas Girdauskas

J. Clin. Med. 2023, 12(8), 2915; https://doi.org/10.3390/jcm12082915 - 17 Apr 2023

Viewed by 670

Abstract

Objective: At the tissue level, disruption of the extracellular matrix network leads to irreversible cardiac fibrosis, which contributes to myocardial dysfunction. At the myocyte level, downregulation of beta-adrenoceptors (beta-AR) reduces adaptation to increased workload. The aim of our study was to analyse the correlation between myocardial fibrosis and beta-AR sensitivity in patients with aortic valve (AV) disease. Methods: A total of 92 consecutive patients who underwent elective AV surgery between 2017–2019 were included in our study (51 with aortic regurgitation (AR-group); 41 with aortic stenosis (AS-group) and left ventricular (LV) biopsies were obtained intraoperatively. In vitro force contractility testing was performed by measuring beta-AR sensitivity (−log EC₅₀[ISO]). In parallel, a quantitative analysis of myocardial fibrosis burden was performed. Results: Mean age at the time of AV surgery was not statistically different in both groups (AR: 53.3 ± 15.3 years vs. AS: 58.7 ± 17.0 years; p = 0.116). The LV end-diastolic diameter was significantly enlarged in the AR-group when compared to the AS-group (59.4 ± 15.6 vs. 39.7 ± 21.2; p < 0.001). Analysis of beta-AR sensitivity (AR: −6.769 vs. AS: −6.659; p = 0.316) and myocardial fibrosis (AR: 8.9% vs. AS: 11.3%; p = 0.284) showed no significant differences between patients with AS and AR. There was no correlation between myocardial fibrosis and beta-AR sensitivity in the whole study cohort (R = 0.1987; p = 0.100) or in the AS-subgroup (R = 0.009; p = 0.960). However, significant correlation of fibrosis and beta-AR sensitivity was seen in AR-patients (R = 0.363; p = 0.023). Conclusion: More severe myocardial fibrosis was associated with reduced beta-AR sensitivity in patients presenting with AR but not with AS. Therefore, our results suggest that in patients with AR, cellular myocardial dysfunction is present and correlates with the extent of myocardial fibrosis in the myocardium. Full article

(This article belongs to the Special Issue Clinical Advances in Cardiothoracic Surgery: Towards Individualized Treatment of Valvular Heart Disease)

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Open AccessArticle

Correlation of Myocardial Native T1 and Left Ventricular Reverse Remodeling after Valvular Surgery

Tatiana M. Sequeira-Gross

Hermann Reichenspurner

and

Evaldas Girdauskas

J. Clin. Med. 2023, 12(7), 2649; https://doi.org/10.3390/jcm12072649 - 02 Apr 2023

Viewed by 674

Abstract

Myocardial native T1 is a known cardiovascular magnetic resonance (CMR) imaging biomarker to quantify diffuse myocardial fibrosis in valvular cardiomyopathy. We hypothesized that diffuse myocardial fibrosis assessed by preoperative T1 mapping might correlate with LV reverse remodeling after valvular surgery. A prospective monocentric cohort study was conducted including 79 consecutive patients with valvular cardiomyopathy referred for surgical treatment of severe aortic or severe functional mitral regurgitation. Native T1 values were assessed by CMR before surgery. LV geometry parameters (i.e., LVEDV, LVESV) were obtained by 2D transthoracic echocardiography before and six months after surgery. Postoperative change of LV geometry parameters was calculated as delta (∆) variable (i.e., six months value minus baseline value). Mean native T1 was 1047 ± 39 ms, mean ∆LVEDV was −33 ± 42 mL, and mean ∆LVESV was −15 ± 27 mL. Native T1 values correlated with ∆LVEDV (Pearson r = 0.29; p = 0.009) and ∆LVESV (Pearson r = 0.29; p = 0.015). Native T1 values < 1073 ms were identified as independent predictor of postoperative reduction of LVEDV (HR 3.0; 95%-CI: 1.1–8.0; p = 0.03) and LVESV (HR 2.9; 95%-CI: 1.1–7.4; p = 0.03). Diffuse myocardial fibrosis assessed by myocardial native T1 correlates with LV reverse remodeling at six months after valvular surgery. T1 mapping may be a valuable tool to predict LV reverse remodeling in valvular heart disease. Full article

(This article belongs to the Special Issue Clinical Advances in Cardiothoracic Surgery: Towards Individualized Treatment of Valvular Heart Disease)

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Special Issue "Clinical Advances in Cardiothoracic Surgery: Towards Individualized Treatment of Valvular Heart Disease"

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