Myocardial Edema: Pathophysiological Basis and Implications for Cardiac Disease

Abstract

The compartmentalization of water within the myocardium is essential to maintain normal cardiac function. Myocardial fluid balance is achieved by a complex interaction between microvascular filtration, interstitial hydration, cardiomyocyte water uptake and lymphatic removal. Despite the existence of multiple compensatory mechanisms, failure in one or more of these components frequently results in edema, defined as the accumulation of interstitial and intracellular water. Myocardial edema has been shown to disrupt cardiomyocyte contractile apparatus and intercellular connections, hamper oxygen uptake and reduce the washout of waste products and inflammatory mediators, ultimately impairing myocardial performance. Accordingly, advances in cardiac imaging led to the recognition of myocardial edema as a clinically relevant finding with prognostic implications in several clinical situations. The present review aims to summarize the current knowledge on the physiology of myocardial fluid balance, evaluating the functional and clinical consequences of its perturbation and exploring potential novel therapeutic avenues targeting myocardial edema.