Acute heart failure and valvular heart disease: A scientific statement of the Heart Failure Association, the Association for Acute CardioVascular Care and the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology

Abstract

Acute heart failure (AHF) represents a broad spectrum of disease states, resulting from the interaction between an acute precipitant and a patient's underlying cardiac substrate and comorbidities. Valvular heart disease (VHD) is frequently associated with AHF. AHF may result from several precipitants that add an acute haemodynamic stress superimposed on a chronic valvular lesion or may occur as a consequence of a new significant valvular lesion. Regardless of the mechanism, clinical presentation may vary from acute decompensated heart failure to cardiogenic shock. Assessing the severity of VHD as well as the correlation between VHD severity and symptoms may be difficult in patients with AHF because of the rapid variation in loading conditions, concomitant destabilization of the associated comorbidities and the presence of combined valvular lesions. Evidence‐based interventions targeting VHD in settings of AHF have yet to be identified, as patients with severe VHD are often excluded from randomized trials in AHF, so results from these trials do not generalize to those with VHD. Furthermore, there are not rigorously conducted randomized controlled trials in the setting of VHD and AHF, most of the data coming from observational studies. Thus, distinct to chronic settings, current guidelines are very elusive when patients with severe VHD present with AHF, and a clear‐cut strategy could not be yet defined. Given the paucity of evidence in this subset of AHF patients, the aim of this scientific statement is to describe the epidemiology, pathophysiology, and overall treatment approach for patients with VHD who present with AHF.

Acute Heart Failure During the Peripartum Period Due to Aggravated Tricuspid Regurgitation

“…Recent recommendations encourage the interdisciplinary management of patients with HF and VHD. 7 Symptoms or progression of chamber dilatation should trigger early referral to a center with competence in valve treatment, including emerging minimally invasive treatment options.…”

Epidemiology, pathophysiology, diagnosis and management of chronic right‐sided heart failure and tricuspid regurgitation. A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC

“…Acute RHF as well as VHD in acute HF have been discussed in previous Heart Failure Association (HFA) position statements. 15,16 Thus, we will focus only on chronic HF and TR in the present article.…”

Acute Heart Failure Is a Malignant Process: But We Can Induce Remission

“…Valvular heart disease is frequently associated with AHF. 23 AHF may result from either a new or a worsening acute valvular lesion, or it may be attributable to combined precipitants (such as an infection or arrhythmia) in a patient with significant valvular heart disease. The severity of the AHF event associated with valvular heart disease may vary from mild to frank cardiogenic shock.…”

“…In some cases, the treatment implications of precipitating factors discovered during the AHF admission workup are less clear (eg, with valvular heart disease). 23 Because no prospective randomized studies have been conducted examining interventions in patients with AHF and valvular heart disease, and patients with severe valvular heart diseases are commonly excluded from AHF randomized trials, strong recommendations cannot be made, especially with respect to timing and type of procedures. However, because patients with AHF with valvular heart disease are sick with multiple comorbidities and end organ dysfunction, it is likely that percutaneous treatments will be preferred to surgical interventions; some studies are being planned to address those even in patients with cardiogenic shock.…”