Challenges and Opportunities in Valvular Heart Disease: From Molecular Mechanisms to the Community

Valvular heart disease (VHD) takes a central stage in contemporary cardiology due to population aging and immense progress in percutaneous approaches to its treatment.VHD continues to be a major cause of death and suffering in both developed countries and low-and middle-income countries.In the United States, moderate-to-severe VHD occurs in 13.2% of people aged ≥75 years, with 2.8% for symptomatic calcific aortic stenosis and 9.3% for mitral valve regurgitation. 1 The right-sided pulmonary and tricuspid valves can also develop disease, though they represent only 25% of all VHD-associated deaths. 2 Worldwide, rheumatic heart disease affects 33.4 million individuals in endemic regions, progressing from childhood and increasing maternal mortality. 3Strikingly, there are no effective or approved medicines for any form of VHD.The only available therapy remains valve repair or replacement, which is a highly specialized, invasive, and costly procedure primarily performed in late-stage disease and often unavailable in developing countries.Imaging has been crucial in revealing VHD mechanisms through the assessment of morphological and functional changes.In one of its most powerful scientific applications, imaging provides a window into basic cellular, molecular, and biomechanical mechanisms of VHD and valvular pathophysiological adaptation.