Characteristics, Management, and Outcomes of Patients with Multiple Native Valvular Heart Disease: A Substudy of the EURObservational Research Programme Valvular Heart Disease II Survey.
Résumé
AIMS: To assess the characteristics, management, and survival of patients with multiple native valvular heart disease (VHD). METHODS AND RESULTS: Among the 5087 patients with ≥q1 severe left-sided native VHD included in the EURObservational VHD II Survey (maximum 3-month recruitment period per centre between January and August 2017 with a 6-month follow-up), 3571 had a single left-sided VHD (Group A, 70.2%), 363 had one severe left-sided VHD with moderate VHD of the other ipsilateral valve (Group B, 7.1%), and 1153 patients (22.7%) had ≥q2 severe native VHDs (left-sided and/or tricuspid regurgitation, Group C). Patients with multiple VHD (Groups B and C) were more often women, had greater congestive heart failure (CHF) and comorbidity, higher left atrial volumes and pulmonary pressures, and lower ejection fraction than Group A patients (all P\,≤q\,0.01). During the index hospitalization, 36.7% of Group A (n\,=\,1312), 26.7% of Group B (n\,=\,97), and 32.7% of Group C (n\,=\,377) underwent valvular intervention (P\,<\,0.001). Six-month survival was better for Group A than for Group B or C (both P\,<\,0.001), even after adjustment for age, sex, body mass index, and Charlson index [hazard ratio (HR) 95% confidence interval (CI) 1.62 (1.10-2.38) vs. Group B and HR 95% CI 1.72 (1.32-2.25) vs. Group C]. Groups B and C had more CHF at 6 months than Group A (both P\,<\,0.001). Factors associated with mortality in Group C were age, CHF, and comorbidity (all P\,<\,0.010). CONCLUSION: Multiple VHD is common, encountered in nearly 30% of patients with left-sided native VHD, and associated with greater cardiac damage and leads to higher mortality and more heart failure at 6 months than single VHD, yet with lower rates of surgery.