Myocardial fibrosis in rheumatic heart disease: emerging concepts and clinical implications

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

Wishnu Aditya Widodo¹  Teuku Muhammad Haykal Putra¹  Quang Ngoc Nguyen²  Jack Wei Chieh Tan³  Sidhi Laksono⁴  Jagat Narula⁵  Rodrigo Rodriguez-Fernandez⁶  Maria Elfiana⁷ 

[1] Department of Cardiology and Vascular Medicine, Jakarta Heart Center, Jakarta, Indonesia;Department of Cardiology, Hanoi Medical University, Hanoi, Vietnam;Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore;Faculty of Medicine, Universitas Muhammadiyah Prof. DR. Hamka, Tangerang, Indonesia;Icahn School of Medicine at Mount Sinai, New York, NY, United States;International SOS, London, United Kingdom;Research Unit, Jakarta Heart Center, Jakarta, Indonesia;

关键词: myocardial fibrosis;    rheumatic heart disease;    Group A Streptoccocus;    cross reactivity;    LV dysfunction;   

DOI  :  10.3389/fcvm.2023.1230894

 received in 2023-05-29, accepted in 2023-07-03,  发布年份 2023

来源: Frontiers

【 摘 要 】

Rheumatic heart disease (RHD) remains a significant cardiovascular burden in the world even though it is no longer common in affluent countries. Centuries of history surrounding this disease provide us with a thorough understanding of its pathophysiology. Infections in the throat, skin, or mucosa are the gateway for Group A Streptococcus (GAS) to penetrate our immune system. A significant inflammatory response to the heart is caused by an immunologic cascade triggered by GAS antigen cross-reactivity. This exaggerated immune response is primarily responsible for cardiac dysfunction. Recurrent inflammatory processes damage all layers of the heart, including the endocardium, myocardium, and pericardium. A vicious immunological cycle involving inflammatory mediators, angiotensin II, and TGF-β promotes extracellular matrix remodeling, resulting in myocardial fibrosis. Myocardial fibrosis appears to be a prevalent occurrence in patients with RHD. The presence of myocardial fibrosis, which causes left ventricular dysfunction in RHD, might be utilized to determine options for treatment and might also be used to predict the outcome of interventions in patients with RHD. This emerging concept of myocardial fibrosis needs to be explored comprehensively in order to be optimally utilized in the treatment of RHD.

【 授权许可】

Unknown   
© 2023 Putra, Rodriguez-Fernandez, Widodo, Elfiana, Laksono, Nguyen, Tan and Narula.