Editorial: Comprehensive approaches to multivalvular disease: diagnosis, treatment, and innovation
Year: 2026
Type: editorial
Abstract: Valvular heart disease remains a major challenge in contemporary cardiology, owing in part to the complex interplay among loading conditions, filling pressures, cardiac remodeling, and ventricular function, which contributes to substantial variability in clinical presentation and disease progression. Further, the assessment and management of multivalvular disorders is substantially less well defined than those of isolated valvular lesions, potentially leading to mistreatment. Our current Research Topic aims to address these challenges by bringing together contemporary work spanning novel diagnostic technologies, perioperative risk stratification, and advanced echocardiographic phenotyping. The four manuscripts published within this collection illustrate innovative directions in the evolving field of valvular heart disease, while highlighting areas in which additional research is needed.The first article, by Li and colleagues, deals with intraoperative hemodynamic assessment during valve replacement surgery. In a retrospective matched cohort of 162 patients, the investigators compared transesophageal echocardiography (TEE) combined with FloTrac monitoring with TEE accompanied by conventional invasive arterial pressure monitoring.Significant differences between monitoring strategies were observed in several hemodynamic variables, including cardiac output, cardiac index, stroke volume variation, and their temporal behavior during surgery. However, despite the greater hemodynamic detail provided by TEE plus FloTrac, postoperative complication rates, including cognitive decline, did not differ significantly between groups, suggesting that a intraprocedural physiological measurement does not necessarily translate into improved clinical outcomes. Once again, further prospective studies are needed to investigate the prognostic impact of monitoring protocols during valvular The second paper, by Close and colleagues, reports on the detection of isolated aortic stenosis using auscultation recordings obtained with unmodified mobile phones and analyzed by computational nonlinear dynamics. In this single-center pilot study of 248 participants, the bestperforming model for aortic stenosis achieved an area under the curve of 0.872 and a sensitivity of 92.3%. Interestingly, recordings obtained by study personnel and by participants themselves appeared to be equally informative, suggesting feasibility of patient-generated recordings. The implications of this work extend beyond aortic stenosis itself, as access to definitive diagnostic tests requiring appropriately trained personnel is limited in general, and the need for low-cost screening tools is as high as ever. While thought-provoking, the study's findings require external prospective validation across broader populations as well as evaluation of whether such screening improves referral, diagnosis, treatment, and outcomes.The third article, by Gharehdaghi and colleagues, focuses on risk stratification in isolated tricuspid regurgitation (TR). In this multicenter retrospective study of of 104 patients with at least moderate TR, the TRI-SCORE independently forecasted the risk for all-cause mortality and/or heart failure hospitalizations following both conservative and invasive (i.e., surgery or transcatheter edge-to-edge repair) management. Moreover, one-year mortality increased progressively across low-, intermediate-, and high-risk categories, from 7% to 13% and 33%, respectively. These findings are particularly relevant, as proper risk stratification is essential for successful treatment and the avoidance of a futile one. Yet, the absence of a significant survival difference between treatment groups in this observational cohort highlights the limitations of non-randomized comparisons.Last but not least, Liao and colleagues explore advanced echocardiographic markers in medically managed secondary mitral regurgitation. Among 399 patients followed for a median of
Authors: Alon Shechter, Anastasios Apostolos
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7214975445