Contemporary Presentation and Management of Valvular Heart Disease: The EURObservational Research Programme Valvular Heart Disease II Survey
Bernard Iung, Victoria Delgado, Raphael Rosenhek, Susanna Price, Bernard Prendergast, Olaf Wendler, Michele De Bonis, Christophe Tribouilloy, Arturo Evangelista, Alexander Bogachev-Prokophiev, Astrid Apor, Hüseyin Ince, Cécile Laroche, Bogdan A Popescu, Luc Piérard, Michael Haude, Gerhard Hindricks, Frank Ruschitzka, Stefan Windecker, Jeroen J Bax, Aldo Maggioni, Alec Vahanian, EORP VHD II Investigators, Artan Goda, Julia Mascherbauer, Fuad Samadov, Katerina Linhartova, Nikolaj Ihlemann, Magdy Abdelhamid, Antti Saraste, Christophe Tribouilloy, Elizabeta Srbinovska Kostovska, Gani Bajraktari, Erkin Mirrakhimov, Andrejs Erglis, Vaida Mizariene, Daniela Cassar, Victoria Delgado, Lidia Tomkiewicz-Pajak, Regina Ribeiras, Branko Beleslin, Iveta Simkova, Arturo Evangelista, Sait Mesut Dogan, Shelley Rahman-Haley, Bernard Iung, Jeroen Bax, Susanna Price, Michele Debonis, Bernard Prendergast, Raphael Rosenhek, Olaf Wendler, Frank Ruschitzka, Michael Haude, Bogdan A Popescu, Stephan Windecker, Gerhard Hindricks, Alec Vahanian, Aldo Maggioni, Souad Mekhaldi, Katell Lemaitre, Sebastien Authier, Artan Goda, Fuad Samadov, Agnés Pasquet, Katerina Linhartova, Nikolaj Ihlemann, Magdy Abdelhamid, Antti Saraste, Astrid Apor, Gani Bajraktari, Erkin Mirrakhimov, Daniela Cassar Demarco, Regina Ribeiras, Alexander Bogachev-Prokophiev, Ervina Shirka, Elona Dado, Eliverta Zera, Loreta Bica, Maria Heger, Daniel Basic, Yasmin Rustamova, Tofig Jahangirov, Tahir Ahmedov, Saleh Huseynov, Luc Pierard, Patrizio Lancellotti, Bernard Cosyns, Gery Van Camp, Nico Van de Veire, Stepanka Sindelarova, Katerina Linhartova, Marian Branny, Ilona Parenicova, Dagmar Jungwirtova Vondrackova, Miroslav Homza, Jiri Ostransky, Hosam Hasan-Ali, Yasser Abdelhady, Mohamed Hassan, Hytham Soliman, Ahmad Elsayed Mostafa, Moemen Moaaz, Ghada Kazamel, Yasser Sadek, Sherif Eltobgi, Diaa Kamal, Minna Kylmala, Anu Turpeinen, Jean-Luc Monin, Yannick Jobic, David Attias, Julien Magne, Sylvestre Marechaux, Erwan Donal, Loic Biere, Anne Bernard, Magalie Daudin, Moukda Khounlaboud, Gilbert Habib, Martin Audonnet, Franck Thuny, Alain Berenfeld, Emmanuel Sorbets, Arthur Charbonnier, Fabrice Bauer, Clarisse Menager-Gangloff, Marija Gjerakorska-Radovikj, Slavica Jordanova, Evren Caglayan, Rainer Hambrecht, Kristin Lehnert, Ibrahim Akin, Lars Maier, Georg Nickenig, Werner Scholtz, Paul-Christian Schulze, Matthias Heintzen, Tienush Rassaf, Fikret Er, Marc Vorphal, Holger Sigusch, Konstantinos Spargias, Vasileios Kamperidis, Vasileios Sachpekidis, Vasileios Bellos, Ioannis Kanakakis, Michail Papafaklis, Athanasios Makris, Leonidas Poulimenos, Andreas Katsaros, Konstantinos Lampropoulos, Elektra Bartha, Andras Zsary, Eva Jebelovszki, Tunde Borsanyi, Attila Cziraki, Geza Lupkovics, Zoltan Jarai, Pranvera Ibrahimi, Rano Arapova, Elmira Laahunova, Gita Rancane, Greta Radauskaite, Raugaliene Raugaliene, Robert George Xuereb, Roxana Djaberi, Monika Komar, Piotr Szymanski, Beata Zaborska, Katarzyna Mizia-Stec, Mateusz Regulski, Piotr Bogacki, Ewa Sedziwy, Klaudiusz Komor, Jaroslaw Myszor, Isabel Joao, Rui Martins, Sofia Cabral, Paula Gago, Goncalo Cardoso, Ines Almeida, Nuno Antunes, Sofia Carvalho, Ana Galrinho, Carla Sousa, Lucica Grigorica, Adriana Mitre, Adina Ionac, Diana Tint, Antoniu Octavian Petris, Andreea Popescu, Roxana Onut, Calin Pop, Catalin Usurelu, Ruxandra Beyer, Constantin Militaru, Gabriela Eminovici, Catalina Arsenescu-Georgescu, Olga Irtyuga, Elena Semenova, Sergey Boldyrev, Dmitry Kozmin, Yuriy Gross, Alexander Zotov, Dmitry Kuznetsov, Evgeniy Nemchenko, Oleg Kulumbegov, Ramis Jakubov, Sergei Stefanov, Yuri Schneider, Valeriy Tsechanovich, Tatyana Voronva, Mikhail Fomenko, Alisher Gamzaev, Olga Mayorova, Elena Skripkina, Vasilya Safina, Yaroslav Slastin, Tatyana Koroleva, Larisa Polyaeva, Ivan Tarasenko, Svetlana Alekseeva, Victorya Magamet, Igor Medvedev, Liliya Khilova, Artem Verevetinov, Anastazija Stojsic-Milosavljevic, Natasa Markovic Nikolic, Dimitra Kalimanovska Ostric, Dusan Ruzicic, Savo Pavlovic, Jelica Milosavljevic, Ljiljana Jovovic, Roman Margoczy, Gabriel Valocik, Martin Studencan, Francisco Calvo Iglesias, Irene Mendez, Ariana Gonzalez Gomez, Pedro L Sanchez Fernandez, Gonzalo de la Morena Valenzuela, Merce Cladellas, David Villagomez Villegas, Sergio Moral, Irene Menduina Gallego, Rafael Paya, Luis Caballero, Ramon Rubio Paton, Cristina Iglesia-Carreno, Esther Esteban, Cristina Mitroi, Maria Teresa Alberca, Alfonso Valle, Maria Jose Molina-Mora, Noelia Castro, Nurten Sayar, Abdullah Orhan Demirtas, Asuman Yesilay, Serafettin Demir, Abdi Bozkurt, Batur Kanar, Naile Eris Gudul, Tarik Yildirim, Gokay Taylan, Kadir Ugur Mert, Mustafa Adem Yilmaztepe, Gurbet Ozge Mert, Kahraman Cosansu, Muhammet Rasit Sayin, Turgut Karabag, Hervé Druais, Cécile Laroche, Hüseyin Ince, Hélène Bardet, François Plurien, Renaud Gervais, Iveta Sime, Sofia Cabral, Bernard Iung, Victoria Delgado, Raphael Rosenhek, Susanna Price, Bernard Prendergast, Olaf Wendler, Michele De Bonis, Christophe Tribouilloy, Arturo Evangelista, Alexander Bogachev-Prokophiev, Astrid Apor, Hüseyin Ince, Cécile Laroche, Bogdan A Popescu, Luc Piérard, Michael Haude, Gerhard Hindricks, Frank Ruschitzka, Stefan Windecker, Jeroen J Bax, Aldo Maggioni, Alec Vahanian, EORP VHD II Investigators, Artan Goda, Julia Mascherbauer, Fuad Samadov, Katerina Linhartova, Nikolaj Ihlemann, Magdy Abdelhamid, Antti Saraste, Christophe Tribouilloy, Elizabeta Srbinovska Kostovska, Gani Bajraktari, Erkin Mirrakhimov, Andrejs Erglis, Vaida Mizariene, Daniela Cassar, Victoria Delgado, Lidia Tomkiewicz-Pajak, Regina Ribeiras, Branko Beleslin, Iveta Simkova, Arturo Evangelista, Sait Mesut Dogan, Shelley Rahman-Haley, Bernard Iung, Jeroen Bax, Susanna Price, Michele Debonis, Bernard Prendergast, Raphael Rosenhek, Olaf Wendler, Frank Ruschitzka, Michael Haude, Bogdan A Popescu, Stephan Windecker, Gerhard Hindricks, Alec Vahanian, Aldo Maggioni, Souad Mekhaldi, Katell Lemaitre, Sebastien Authier, Artan Goda, Fuad Samadov, Agnés Pasquet, Katerina Linhartova, Nikolaj Ihlemann, Magdy Abdelhamid, Antti Saraste, Astrid Apor, Gani Bajraktari, Erkin Mirrakhimov, Daniela Cassar Demarco, Regina Ribeiras, Alexander Bogachev-Prokophiev, Ervina Shirka, Elona Dado, Eliverta Zera, Loreta Bica, Maria Heger, Daniel Basic, Yasmin Rustamova, Tofig Jahangirov, Tahir Ahmedov, Saleh Huseynov, Luc Pierard, Patrizio Lancellotti, Bernard Cosyns, Gery Van Camp, Nico Van de Veire, Stepanka Sindelarova, Katerina Linhartova, Marian Branny, Ilona Parenicova, Dagmar Jungwirtova Vondrackova, Miroslav Homza, Jiri Ostransky, Hosam Hasan-Ali, Yasser Abdelhady, Mohamed Hassan, Hytham Soliman, Ahmad Elsayed Mostafa, Moemen Moaaz, Ghada Kazamel, Yasser Sadek, Sherif Eltobgi, Diaa Kamal, Minna Kylmala, Anu Turpeinen, Jean-Luc Monin, Yannick Jobic, David Attias, Julien Magne, Sylvestre Marechaux, Erwan Donal, Loic Biere, Anne Bernard, Magalie Daudin, Moukda Khounlaboud, Gilbert Habib, Martin Audonnet, Franck Thuny, Alain Berenfeld, Emmanuel Sorbets, Arthur Charbonnier, Fabrice Bauer, Clarisse Menager-Gangloff, Marija Gjerakorska-Radovikj, Slavica Jordanova, Evren Caglayan, Rainer Hambrecht, Kristin Lehnert, Ibrahim Akin, Lars Maier, Georg Nickenig, Werner Scholtz, Paul-Christian Schulze, Matthias Heintzen, Tienush Rassaf, Fikret Er, Marc Vorphal, Holger Sigusch, Konstantinos Spargias, Vasileios Kamperidis, Vasileios Sachpekidis, Vasileios Bellos, Ioannis Kanakakis, Michail Papafaklis, Athanasios Makris, Leonidas Poulimenos, Andreas Katsaros, Konstantinos Lampropoulos, Elektra Bartha, Andras Zsary, Eva Jebelovszki, Tunde Borsanyi, Attila Cziraki, Geza Lupkovics, Zoltan Jarai, Pranvera Ibrahimi, Rano Arapova, Elmira Laahunova, Gita Rancane, Greta Radauskaite, Raugaliene Raugaliene, Robert George Xuereb, Roxana Djaberi, Monika Komar, Piotr Szymanski, Beata Zaborska, Katarzyna Mizia-Stec, Mateusz Regulski, Piotr Bogacki, Ewa Sedziwy, Klaudiusz Komor, Jaroslaw Myszor, Isabel Joao, Rui Martins, Sofia Cabral, Paula Gago, Goncalo Cardoso, Ines Almeida, Nuno Antunes, Sofia Carvalho, Ana Galrinho, Carla Sousa, Lucica Grigorica, Adriana Mitre, Adina Ionac, Diana Tint, Antoniu Octavian Petris, Andreea Popescu, Roxana Onut, Calin Pop, Catalin Usurelu, Ruxandra Beyer, Constantin Militaru, Gabriela Eminovici, Catalina Arsenescu-Georgescu, Olga Irtyuga, Elena Semenova, Sergey Boldyrev, Dmitry Kozmin, Yuriy Gross, Alexander Zotov, Dmitry Kuznetsov, Evgeniy Nemchenko, Oleg Kulumbegov, Ramis Jakubov, Sergei Stefanov, Yuri Schneider, Valeriy Tsechanovich, Tatyana Voronva, Mikhail Fomenko, Alisher Gamzaev, Olga Mayorova, Elena Skripkina, Vasilya Safina, Yaroslav Slastin, Tatyana Koroleva, Larisa Polyaeva, Ivan Tarasenko, Svetlana Alekseeva, Victorya Magamet, Igor Medvedev, Liliya Khilova, Artem Verevetinov, Anastazija Stojsic-Milosavljevic, Natasa Markovic Nikolic, Dimitra Kalimanovska Ostric, Dusan Ruzicic, Savo Pavlovic, Jelica Milosavljevic, Ljiljana Jovovic, Roman Margoczy, Gabriel Valocik, Martin Studencan, Francisco Calvo Iglesias, Irene Mendez, Ariana Gonzalez Gomez, Pedro L Sanchez Fernandez, Gonzalo de la Morena Valenzuela, Merce Cladellas, David Villagomez Villegas, Sergio Moral, Irene Menduina Gallego, Rafael Paya, Luis Caballero, Ramon Rubio Paton, Cristina Iglesia-Carreno, Esther Esteban, Cristina Mitroi, Maria Teresa Alberca, Alfonso Valle, Maria Jose Molina-Mora, Noelia Castro, Nurten Sayar, Abdullah Orhan Demirtas, Asuman Yesilay, Serafettin Demir, Abdi Bozkurt, Batur Kanar, Naile Eris Gudul, Tarik Yildirim, Gokay Taylan, Kadir Ugur Mert, Mustafa Adem Yilmaztepe, Gurbet Ozge Mert, Kahraman Cosansu, Muhammet Rasit Sayin, Turgut Karabag, Hervé Druais, Cécile Laroche, Hüseyin Ince, Hélène Bardet, François Plurien, Renaud Gervais, Iveta Sime, Sofia Cabral
Abstract
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.
Keywords: echocardiography; guidelines as topic; heart valve diseases; transcatheter aortic valve replacement.
Source: PubMed