Valvular heart disease and cardiomyopathy: reappraisal of their interplay

Abstract

Cardiomyopathies and valvular heart diseases are typically considered distinct diagnostic categories with dedicated guidelines for their management. However, the interplay between these conditions is increasingly being recognized and they frequently coexist, as in the paradigmatic examples of dilated cardiomyopathy and hypertrophic cardiomyopathy, which are often complicated by the occurrence of mitral regurgitation. Moreover, cardiomyopathies and valvular heart diseases can have a shared aetiology because several genetic or acquired diseases can afect both the cardiac valves and the myocardium. In addition, the association between cardiomyopathies and valvular heart diseases has important prognostic and therapeutic implications. Therefore, a better understanding of their shared pathophysiological mechanisms, as well as of the prevalence and predisposing factors to their association, might lead to a diferent approach in the risk stratifcation and management of these diseases. In this Review, we discuss the diferent scenarios in which valvular heart diseases and cardiomyopathies coexist, highlighting the need for an improved classifcation and clustering of these diseases with potential repercussions in the clinical management and, particularly, personalized therapeutic approaches.