Early detection of subclinical myocardial disease using novel imaging and biomarkers may facilitate timely preventive interventions to avert overt heart failure.
Subclinical myocardial disease refers to pathological cardiac changes that precede overt symptoms. It represents an emerging frontier in cardiovascular disease prevention; wherein early detection of myocardial dysfunction could allow timely intervention to avert heart failure (HF) and other outcomes. This narrative review summarizes the current and emerging tools for detecting subclinical myocardial disease, including advanced cardiac imaging and circulating biomarkers, and discusses their potential to improve risk stratification and preventive care in asymptomatic high-risk individuals. Novel echocardiographic measures such as global longitudinal strain (GLS) can unmask subtle systolic dysfunction despite preserved ejection fraction, while cardiac magnetic resonance (CMR) tissue mapping (T1 mapping and extracellular volume ECV fraction) enables quantification of diffuse myocardial fibrosis. Circulating biomarkers of cardiomyocyte injury and hemodynamic stress, namely high-sensitivity cardiac troponins and natriuretic peptides, offer quantitative indices of subclinical myocardial damage and wall stress that correlate with future HF risk. Positron emission tomography (PET) imaging provides sensitive detection of myocardial inflammation and microvascular dysfunction. We highlight how integrating these modalities can identify high-risk patients in the pre-HF stage (ACC/AHA Stage B), defined by structural or functional cardiac abnormalities without symptoms, allowing initiation of preventive therapies.
Sheth et al. (Wed,) studied this question.