ILD Does Not Directly Cause Valvular Heart Disease
Interstitial lung disease does not cause valvular heart disease—the cardiac complications of ILD are limited to pulmonary vascular disease, right ventricular dysfunction, and pulmonary hypertension, not structural valve pathology. 1
Cardiac Complications That Actually Occur in ILD
The cardiovascular abnormalities in ILD are well-characterized and consistently documented across guidelines:
Pulmonary vascular dysfunction and right ventricular impairment are the primary cardiac manifestations, resulting from hypoxic vasoconstriction and increased right ventricular afterload 1
Pulmonary hypertension develops in up to 85% of patients with end-stage fibrotic ILD and is a major contributor to morbidity and mortality 2, 3
Elevated pulmonary artery pressure is common in advanced ILD, particularly affecting right-sided cardiac function 1
Reduced stroke volume with elevated heart rate during exercise reflects the cardiovascular dysfunction, but this is hemodynamic rather than structural valve disease 1
Why the Confusion May Arise
Specific ILD Subtypes with Cardiac Involvement
Some specific forms of ILD have associated cardiac manifestations that could theoretically be confused with ILD-caused valve disease:
Sarcoidosis can cause disproportionate cardiovascular abnormalities due to left- and right-sided myocardial involvement (infiltrative cardiomyopathy), but this is direct cardiac sarcoid infiltration, not a consequence of the lung disease itself 1
Connective tissue disease-associated ILD (particularly systemic sclerosis) may have concurrent cardiac involvement, but the cardiac disease is part of the systemic CTD, not caused by the ILD component 1
Ischemic Heart Disease Association
ILD is independently associated with increased risk of ischemic heart disease (HR 1.85) and myocardial infarction (HR 1.74), particularly in patients aged 60-69 years 4
This represents shared risk factors and pathophysiological pathways, not causation of valvular disease 4
Clinical Pitfalls to Avoid
Do not attribute valvular heart disease to ILD itself. If a patient with ILD presents with valvular pathology, search for alternative explanations:
- Concurrent rheumatic heart disease
- Degenerative valve disease
- Endocarditis (particularly relevant if the patient has other risk factors) 1
- Systemic disease affecting both lungs and heart (e.g., connective tissue disease, sarcoidosis with cardiac involvement)
The right-sided cardiac dysfunction in ILD is functional, not structural valve disease. Signs of tricuspid insufficiency may develop secondary to pulmonary hypertension and right ventricular dilation, but this is functional regurgitation from annular dilation, not primary valve pathology 1