Novel echocardiographic insights in valvular and myocardial heart diseases

Abstract

This thesis investigates the role of advanced echocardiography in the assessment and risk stratification of patients with valvular heart disease and cardiomyopathies with a hypertrophic phenotype. It focuses on novel echocardiographic markers that provide information beyond conventional measures of cardiac structure and function, including left ventricular global longitudinal strain (LVGLS), left ventricular myocardial work, right ventricular–pulmonary artery (RV-PA) coupling, and right ventricular strain.

The first part evaluates advanced echocardiographic parameters in valvular heart diseases. It examines the prognostic value of LVGLS in patients with atrial functional mitral regurgitation, chamber abnormalities in Barlow’s disease, myocardial work in chronic aortic regurgitation, and the evolution of RV-PA coupling following transcatheter aortic valve replacement in aortic stenosis.

The second part explores the application of advanced echocardiography in hypertrophic cardiomyopathies and related phenotypes. It investigates right ventricular strain for differentiating Fabry cardiomyopathy from sarcomeric hypertrophic cardiomyopathy, the left atrioventricular coupling index for predicting new-onset atrial fibrillation in hypertrophic cardiomyopathy, and RV-PA coupling for prognostic stratification in transthyretin cardiac amyloidosis. Overall, the thesis highlights the potential of advanced echocardiographic markers to improve disease characterization, identify subclinical myocardial dysfunction, refine risk stratification, and support clinical decision-making and personalized management across diverse cardiovascular clinical settings.