What is considered structural heart disease?

Structural Heart Disease: Definition and Classification

Structural heart disease refers to any abnormality of cardiac structure or function, including disorders of the pericardium, myocardium, endocardium, heart valves, or great vessels, but excluding primary valvular diseases. 1

Components of Structural Heart Disease

Structural heart disease encompasses several types of cardiac abnormalities:

• Disorders of the pericardium (the sac surrounding the heart) 1
• Myocardial disorders (affecting the heart muscle) 1
• Endocardial abnormalities (affecting the inner lining of the heart) 1
• Heart valve disorders (excluding primary valvular diseases in some classifications) 1
• Great vessel abnormalities (affecting the major blood vessels connected to the heart) 1
• Left ventricular hypertrophy or fibrosis 1
• Left ventricular dilatation or hypocontractility 1
• Previous myocardial infarction with resulting structural changes 1

Classification in Heart Failure Staging

Structural heart disease plays a critical role in the ACC/AHA heart failure staging system:

Stage A: At Risk for Heart Failure

• Patients with risk factors but without structural heart disease 1
• Examples: hypertension, diabetes, obesity, family history of cardiomyopathy 1

Stage B: Pre-Heart Failure

• Patients with structural heart disease but no symptoms of heart failure 1
• Examples: 1
  • Left ventricular hypertrophy or fibrosis
  • Left ventricular dilatation or hypocontractility
  • Asymptomatic valvular heart disease
  • Previous myocardial infarction

Stage C: Symptomatic Heart Failure

• Patients with structural heart disease with current or prior symptoms of heart failure 1
• Examples: Dyspnea or fatigue due to left ventricular systolic dysfunction 1

Stage D: Advanced Heart Failure

• Patients with advanced structural heart disease and marked symptoms despite maximal medical therapy 1

Diagnostic Evaluation for Structural Heart Disease

• Echocardiography with Doppler flow studies is the most useful diagnostic test for evaluating structural heart disease 2
• Additional imaging modalities may include: 1
  • Cardiac MRI
  • Cardiac CT
  • Nuclear imaging studies

Common Types of Structural Heart Disease

• Coronary artery disease with previous myocardial infarction - most common form presenting with ventricular tachycardia 3
• Cardiomyopathies (dilated, hypertrophic, restrictive) 3
• Arrhythmogenic right ventricular cardiomyopathy 3
• Cardiac sarcoidosis 3
• Chagas disease affecting cardiac structure 3
• Repaired congenital heart disease 3

Clinical Implications

• Structural heart disease increases risk for:

  • Heart failure progression 1
  • Ventricular arrhythmias 3
  • Sudden cardiac death 3

• Treatment approaches may include: 4, 5

  • Medical therapy (ACE inhibitors, beta-blockers for stage B/C) 1
  • Catheter-based interventions for specific structural abnormalities 5
  • Surgical correction when appropriate 4

Emerging Interventional Approaches

• Transcatheter interventions for structural heart disease are rapidly evolving 5, 6
• These include transcatheter valve replacements, mitral valve repair, and shunt closures 5, 7
• Advanced imaging and 3D printing technologies are increasingly used for procedural planning 6

Remember that structural heart disease represents a broad spectrum of cardiac abnormalities that can lead to heart failure and other complications if left untreated. Early identification and appropriate management are essential for improving outcomes.