Cardiac Damage Staging in Valvular Heart Disease

Valvular heart disease (VHD) is a significant contributor to global cardiovascular morbidity and mortality. Recent advances in transcatheter heart valve therapies have expanded treatable populations and improved outcomes, especially for those at high or intermediate risk. However, clinical management often overlooks the anatomical and functional cardiac damages associated with VHD and overall heart health due to concomitant diseases, focusing primarily on the severity of valvular lesions. To enhance risk stratification and decision-making, Généreux et al proposed a classification scheme for staging cardiac damage (CD) in aortic stenosis (AS) in 2017. This staging system, validated in over 30 studies with approximately 40,000 patients, emphasizes the need to assess extravalvular CD resulting from hemodynamic overload and myocardial dysfunction, which can lead to heart failure. Emerging evidence suggests that CD staging can potentially optimize intervention timing, particularly in asymptomatic patients with severe AS. Integrating CD staging with the traditional severity of VHD may help with the decision-making and improve outcomes. Future research and clinical trials will provide critical insights into the benefits of early intervention based on CD staging. Ultimately, incorporating these CD staging into routine practice could potentially enhance patient management and outcomes across major valvular pathologies.