Contemporary Presentation and Management of Valvular Heart Disease The EURObservational Research Programme Valvular Heart Disease II Survey

J. Milosavljevic , L. Jovovic , R. Margoczy , G. Valocik , M. Studencan , F. C. Iglesias , I Mendez , A. G. Gomez , P. L. Sanchez Fernandez , G. M. Valenzuela , M. Cladellas , D. V. Villegas , S. Moral , I. M. Gallego , R. Paya , L. Caballero , R. R. Paton , E. Esteban (1) , C. Iglesia-Carreno , M. T. Alberca , A. Valle (2) , M. J. Molina-Mora , N. Castro (3) , N. Sayar , A. O. Demirtas , A. Yesilay , S. Demir (4) , A. Bozkurt , B. Kanar , N. E. Gudul , T. Yildirim , G. Taylan , K. U. Mert , M. A. Yilmaztepe , G. O. Mert , K. Cosansu , M. R. Sayin , T. Karabag , Eorp Vhd Ii Investigators , Bernard Iung (5, 6) , Victoria Delgado (7) , Raphael Rosenhek (8) , Susanna Price (9) , Bernard Prendergast (10) , Olaf Wendler , Michele de Bonis , Christophe Tribouilloy (11, 12) , Arturo Evangelista (13) , Alexander Bogachev-Prokophiev , Astrid Apor , Hueseyin Ince , Cecile Laroche (14, 15) , Luc Pierard (16) , Michael Haude (17) , Gerhard Hindricks (18) , Frank Ruschitzka (19) , Stefan Windecker , Jeroen J. Bax , Aldo Maggioni (20) , Alec Vahanian (21) , Souad Mekhaldi , Katell Lemaitre , Sebastien Authier , Herve Druais , A. Goda , J. Mascherbauer , F. Samadov , K. Linhartova , N. Ihlemann , M. Abdelhamid (22) , E. S. Kostovska , G. Bajraktari , E. Mirrakhimov , D. Cassar , R. Ribeiras , B. Beleslin , I Simkova , S. M. Dogan , S. Rahman-Haley , E. Shirka , E. Dado , E. Zera , L. Bica , M. Heger , F. Muslumova , T. Jahangirov , T. Ahmedov , S. Husseynov , A. Pasquet (23) , B. Cosyns (24) , G. van Camp (25) , S. Sindelarova , M. Branny , I Parenicova , D. J. Vondrackova , M. Homza , J. Ostransky , H. Hasan-Ali , Y. Abdelhady , M. Hassan (26) , H. Soliman , A. E. Mostafa , M. Moaaz , G. Kazamel , Y. Sadek , S. Eltobgi , D. Kamal , M. Kylmala , A. Saraste , A. Turpeinen , J. L. Monin , Y. Jobic , D. Attias , J. Magne , Sylvestre Marechaux (12) , E. Donal (27, 28) , L. Biere (29) , A. Bernard (30) , M. Daudin , M. Khounlaboud (31) , G. Habib (32) , H. Bardet , M. Audonnet , F. Thuny (33) , F. Plurien , A. Berenfeld , R. Gervais (34) , E. Sorbets , A. Charbonnier (35) , F. Bauer (36) , C. Menager-Gangloff , M. Gjerakorska-Radovikj , S. Jordanova , E. Caglayan , R. Hambrecht , I Akin , L. Maier , G. Nickenig , W. Scholtz , P. C. Schulze , M. Heintzen , F. Er , H. Sigusch , K. Spargias , V Kamperidis , V Sachpekidis , V Bellos , I Kanakakis , M. Papafaklis , A. Makris , L. Poulimenos , A. Katsaros , K. Lampropoulos , E. Bartha , A. Zsary , E. Jebelovszki , A. Cziraki , T. Borsanyi , G. Lupkovics , Z. Jarai , P. Ibrahimi , R. Arapova , E. Laahunova , A. Erglis (37) , I Sime , G. Rancane , V Mizariene , G. Radauskaite , R. Raugaliene , R. G. Xuereb , R. Djaberi , M. Komar , L. Tomkiewicz-Pajak , P. Szymanski , B. Zaborska , K. Mizia-Stec , M. Regulski , P. Bogacki , E. Sedziwy , K. Komor , J. Myszor , I Joao , R. Martins (38, 39) , S. Cabral , P. Gago (40) , G. Cardoso , I Almeida , N. Antunes (41) , S. Carvalho (42) , A. Galrinho , A. Freitas (43) , L. Grigorica , Bogdan A. Popescu (44, 45) , A. Mitre , A. Ionac , D. Tint , A. Popescu (46) , A. O. Petris , R. Onut , C. Pop , C. Usurelu , R. Beyer (47) , C. Militaru , G. Eminovici , C. Arsenescu-Georgescu , O. Irtyuga , E. Semenova (48) , S. Boldyrev , D. Kozmin , Y. Gross , A. Zotov , D. Kuznetsov , E. Nemchenko , O. Kulumbegov , R. Jakubov , S. Stefanov , Y. Schneider , V Tsechanovich , A. Gamzaev , M. Fomenko , O. Mayorova , E. Skripkina , V Safina , Y. Slastin , T. Koroleva , L. Polyaeva , I Tarasenko , S. Alekseeva , V Magamet , I Medvedev , L. Khilova , A. Verevetinov , A. Stojsic-Milosavljevic , N. M. Nikolic , D. K. Ostric , D. Ruzicic , S. Pavlovic

1 Instituto Universitario de Investigacion de Nanocienca de Aragon
2 IFCA - Instituto de Física de Cantabria
3 AIP - Leibniz Institute for Astrophysics Potsdam
4 RUB - Ruhr University Bochum = Ruhr-Universität Bochum
5 UPD7 - Université Paris Diderot - Paris 7
6 INSERM - Institut National de la Santé et de la Recherche Médicale
7 LUMC - Leiden University Medical Center
8 Medizinische Universität Wien = Medical University of Vienna
9 Department of Imaging Royal Brompton Hospital
10 Guy's and St Thomas' Hospital [London]
11 CHU Amiens-Picardie
12 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517
13 Vall d'Hebron University Hospital [Barcelona]
14 IMAGINE - U1163 - Imagine - Institut des maladies génétiques
15 Hôpital Necker - Enfants Malades [AP-HP]
16 CHU-Liège - Centre Hospitalier Universitaire de Liège
17 Lukaskrankenhaus
18 Leipzig University / Universität Leipzig
19 University Heart Centre Freiburg - Bad Krozingen
20 ANMCO Research Center - Research Center [Associazione Nazionale Medici Cardiologi Ospedalieri]
21 Service de cardiologie
22 Uppsala University
23 SAFRAN Group
24 Laboratory of In Vivo Cellular and Molecular Imaging
25 Université de Lille, Sciences et Technologies
26 LTSI - Laboratoire Traitement du Signal et de l'Image
27 UR Médecine - Université de Rennes - Faculté de Médecine
28 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
29 PMRM - Laboratoire de Protection et Remodelage du Myocarde
30 LabEx LipSTIC - Laboratoire d'Excellence : Lipoprotéines et Santé : prévention et Traitement des maladies Inflammatoires et du Cancer
31 CHU de Saint-Brieuc
32 CHU - Hôpital Lapeyronie [Montpellier]
33 APHM - Assistance Publique - Hôpitaux de Marseille
34 UNICANCER/CRLC - Centre Régional de Lutte contre le Cancer François Baclesse [Caen]
35 Institut de la Vision
36 IRFU - Institut de Recherches sur les lois Fondamentales de l'Univers
37 LU - University of Latvia
38 Dipartimento di Scienza dei Materiali = Department of Materials Science [Milano-Bicocca]
39 MDM Laboratory, IMM-CNR
40 CSIC - Consejo Superior de Investigaciones Cientificas [España] = Spanish National Research Council [Spain]
41 UR REBX - Réseaux épuration et qualité des eaux
42 KAUST - King Abdullah University of Science and Technology [Saudi Arabia]
43 INSTITUTO NACIONAL DE INVESTIGACAO AGRARIA E VETERINARIA VILA DO CONDE PRT
44 Université de Médecine Carol Davila
45 Emergency Institute for Cardiovascular Diseases “Prof. Dr. C.C. Iliescu” [Bucharest, Romania]
46 DIASI (CEA, LIST) - Département Intelligence Ambiante et Systèmes Interactifs
47 HZDR - Helmholtz-Zentrum Dresden-Rossendorf
48 Department of photonics engineering

Background: Valvular heart disease (VHD) is an important cause of mortality and morbidity and has been subject to important changes in management. The VHD II survey was designed by the EURObservational Research Programme of the European Society of Cardiology to analyze actual management of VHD and to compare practice with guidelines. Methods: Patients with severe native VHD or previous valvular intervention were enrolled prospectively across 28 countries over a 3-month period in 2017. Indications for intervention were considered concordant if the intervention was performed or scheduled in symptomatic patients, corresponding to Class I recommendations specified in the 2012 European Society of Cardiology and in the 2014 American Heart Association/American College of Cardiology VHD guidelines. Results: A total of 7247 patients (4483 hospitalized, 2764 outpatients) were included in 222 centers. Median age was 71 years (interquartile range, 62-80 years); 1917 patients (26.5%) were >= 80 years; and 3416 were female (47.1%). Severe native VHD was present in 5219 patients (72.0%): aortic stenosis in 2152 (41.2% of native VHD), aortic regurgitation in 279 (5.3%), mitral stenosis in 234 (4.5%), mitral regurgitation in 1114 (21.3%; primary in 746 and secondary in 368), multiple left-sided VHD in 1297 (24.9%), and right-sided VHD in 143 (2.7%). Two thousand twenty-eight patients (28.0%) had undergone previous valvular intervention. Intervention was performed in 37.0% and scheduled in 26.8% of patients with native VHD. The decision for intervention was concordant with Class I recommendations in symptomatic patients with severe single left-sided native VHD in 79.4% (95% CI, 77.1-81.6) for aortic stenosis, 77.6% (95% CI, 69.9-84.0) for aortic regurgitation, 68.5% (95% CI, 60.8-75.4) for mitral stenosis, and 71.0% (95% CI, 66.4-75.3) for primary mitral regurgitation. Valvular interventions were performed in 2150 patients during the survey; of them, 47.8% of patients with single left-sided native VHD were in New York Heart Association class III or IV. Transcatheter procedures were performed in 38.7% of patients with aortic stenosis and 16.7% of those with mitral regurgitation. Conclusions: Despite good concordance between Class I recommendations and practice in patients with aortic VHD, the suboptimal number in mitral VHD and late referral for valvular interventions suggest the need to improve further guideline implementation.

Mots clés: echocardiography; guidelines as topic; heart valve diseases; transcatheter aortic valve replacement

Domaines: Sciences du Vivant [q-bio]

J. Milosavljevic, L. Jovovic, R. Margoczy, G. Valocik, M. Studencan, et al.. Contemporary Presentation and Management of Valvular Heart Disease The EURObservational Research Programme Valvular Heart Disease II Survey. Circulation, 2019, 140 (14), pp.1156-1169. ⟨10.1161/CIRCULATIONAHA.119.041080⟩. ⟨hal-03583839⟩