Recommendations on the management of the asymptomatic patient with valvular heart disease

Iung, Bernard; Gohlke-Bärwolf, Ch.; Tornos, Pilar; Tribouilloy, Christophe; Hall, Roger; Butchart, Eric G.; Vahanian, Alec

doi:10.1053/euhj.2002.3320

Cited by 228 publications

(144 citation statements)

References 119 publications

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“…1 -4 Anticoagulant therapy is not necessary for all patients with SR and it is recommended to only those carrying high risk. 4 The presence of SEC has been associated with thromboembolic risk and this risk increases with the density of SEC. 1,2,4,5,15 In our study, 47.4% of the patients with dense SEC had thromboembolism.…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosis of dense SEC and initiation of anticoagulant therapy are crucial for such patients. 4 Currently, the most sensitive and specific technique for detecting and assessment of severity of SEC is TEE. 5 -10 Clinical Cardiology DOI:10.1002/clc However, this semi-invasive technique is not well tolerated by all patients, relatively expensive and unsuitable for repeated examinations.…”

Section: Discussionmentioning

confidence: 99%

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Annular Systolic Velocity Predicts the Presence of Spontaneous Echo Contrast in Mitral Stenosis Patients with Sinus Rhythm

Çaylı¹,

Acartürk²,

Kanadaşı³

et al. 2007

Clinical Cardiology

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SummaryOjectives: Thromboembolism is the major cause of morbidity and mortality in mitral stenosis (MS), even in sinus rhythm (SR). Spontaneous echo contrast (SEC) is the strongest predictor of thromboembolism. The aim of the study was to investigate if the annular velocities obtained with tissue Doppler imaging can predict the presence of SEC in MS patients with SR.Methods: One hundred and five MS patients and 100 controls were included. Annular velocities were recorded. All patients underwent transesophageal echocardiography. Subjects were divided into three groups as controls (Group I), the patients without SEC (Group II) and the patients with SEC (Group III).Results: Group III patients had lower ejection fraction, annular systolic velocity, smaller mitral valve area, higher transmitral gradient and larger left atrial size. The annular systolic velocity was the only independent predictor for SEC. The cutoff values of annular systolic velocity for prediction of the presence of any SEC and dense SEC were 13.5 and 11.8 cm/s, respectively.Conclusion: The annular systolic velocity is an independent predictor for SEC in MS patients with SR.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Annular Systolic Velocity Predicts the Presence of Spontaneous Echo Contrast in Mitral Stenosis Patients with Sinus Rhythm

Çaylı¹,

Acartürk²,

Kanadaşı³

et al. 2007

Clinical Cardiology

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“…The outcome end points were time to occurrence of all‐cause death or need for AVR and all‐cause death regardless of whether or not there was AVR, respectively. Clinical decisions regarding medical management and referral for surgery were made by the heart team with the approval of the patient's cardiologist based on ESC guidelines 19, 20. Indications for AVR were occurrence during follow‐up of symptoms, left ventricular dysfunction (LVEF <50%), or symptoms during an exercise test.…”

Section: Methodsmentioning

confidence: 99%

Prognostic Value of Aortic Valve Area by Doppler Echocardiography in Patients With Severe Asymptomatic Aortic Stenosis

Maréchaux

Ringlé

Ruşinaru

et al. 2016

JAHA

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BackgroundThe aim of this study was to evaluate the relationship between aortic valve area (AVA) obtained by Doppler echocardiography and outcome in patients with severe asymptomatic aortic stenosis and to define a specific threshold of AVA for identifying asymptomatic patients at very high risk based on their clinical outcome.Methods and ResultsWe included 199 patients with asymptomatic severe aortic stenosis (AVA ≤1.0 cm2). The risk of events (death or need for aortic valve replacement) increased linearly on the scale of log hazard with decreased AVA (adjusted hazard ratio 1.17; 95% CI 1.06–1.29 per 0.1 cm2 AVA decrement; P=0.002). Event‐free survival at 12, 24, and 48 months was 63±6%, 51±6%, and 34±6%, respectively, for AVA 0.8 to 1 cm2; 49±6%, 36±6%, and 26±6%, respectively, for AVA 0.6 to 0.8 cm2; and 33±8%, 20±7%, and 11±5%, respectively, for AVA ≤0.6 cm2 (P trend=0.002). Patients with AVA ≤0.6 cm2 had a significantly increased risk of events compared with patients with AVA 0.8 to 1 cm2 (adjusted hazard ratio 2.22; 95% CI 1.41–3.52; P=0.001), whereas patients with AVA 0.6 to 0.8 cm2 had an increased risk of events compared with those with AVA 0.8 to 1 cm2, but the difference was not statistically significant (adjusted hazard ratio 1.38; 95% CI 0.93–2.05; P=0.11). After adjustment for covariates and aortic valve replacement as a time‐dependent variable, patients with AVA ≤0.6 cm2 had a significantly greater risk of all‐cause mortality than patients with AVA >0.6 cm2 (hazard ratio 3.39; 95% CI 1.80–6.40; P<0.0001).ConclusionsPatients with severe asymptomatic aortic stenosis and AVA ≤0.6 cm2 displayed an important increase in the risk of adverse events during short‐term follow‐up. Further studies are needed to determine whether elective aortic valve replacement improves outcome in this high‐risk subgroup of patients.

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“…In adults with severe symptomatic aortic stenosis, 2-year mortality is approximately 50% [2] and open surgical aortic valve replacement (SAVR) is the only treatment that has been shown to improve symptoms, functional status and survival [3]. However, nearly 30% of patients with severe and symptomatic aortic valve stenosis are not suitable candidates for surgical treatment because of comorbidities and high surgical risk [4].…”

Section: Introductionmentioning

confidence: 99%

Transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis reduces 1-year mortality compared to standard therapy

Solbiati

Prado

2011

Intern Emerg Med

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Recommendations on the management of the asymptomatic patient with valvular heart disease

Cited by 228 publications

References 119 publications

Annular Systolic Velocity Predicts the Presence of Spontaneous Echo Contrast in Mitral Stenosis Patients with Sinus Rhythm

Annular Systolic Velocity Predicts the Presence of Spontaneous Echo Contrast in Mitral Stenosis Patients with Sinus Rhythm

Prognostic Value of Aortic Valve Area by Doppler Echocardiography in Patients With Severe Asymptomatic Aortic Stenosis

Transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis reduces 1-year mortality compared to standard therapy

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