Mitral regurgitation: new definitions setting the stage of the debate

September 14, 2023

Prof. Delgado

Mitral Highlights course, 2023

Dr. Alisson Duncan

MVT Aortic 2022, vol.1

PPM can be predicted and therefore, prevented

How can we measure, normalize, and standardize various PPM-related assessments and risks?

Make sure to consider the body surface area in relation to the transvalvular gradient, especially during physical activity or exercise

Prof. Dreyfus – MVT Intermediate 2021

Prof. Falk – MVT Intermediate 2021

Prof. Torracca – MVT Intermediate 2021

Prof. Rinaldi – MVT Intermediate 2021

Dr. Farber – MVT Intermediate

Dr. Alison Duncan – MVT Intermediate 2021

Historically, survival data on patients with mild-to-moderate aortic stenosis (AS) have been limited. This situation was addressed in 2019, however, when Strange et al. published their analysis of the relationship between AS severity and mortality in a cohort of 241,303 adult patients in an observational registry. The mean age of patients at baseline was 61 years and median follow up was 1,208 days. Mild and moderate AS were found in 6.7% (n=16,129) and 1.4% (n=3,315) of patients, respectively.1

While it has been observed that severe AS is associated with poor survival, this study also suggests poor survival rates in patients with moderate AS. The five-year mortality rate for these patients was 56% (mean gradient 20.0–39.9 mmHg and/or peak velocity 3.0–3.9 m/s and/or aortic valve area greater than 1 cm²).

Mortality rates according to AS severity

The importance of early referralregular clinical and echocardiographic surveillance and early intervention were emphasised in the recent update to the ESC/EACTS Guidelines for the management of valvular heart disease.In addition to recommendations for an active collaboration among Heart Team members and the inclusion of the informed patient’s preferences when determining optimal treatment, specific recommendations relevant to patients with moderate AS include:2

  • Regular clinical and echocardiographic surveillance where prognosis of patients with normal-flow,
    low-gradient AS and preserved ejection fraction is similar to that of moderate AS
  • Earlier referral if patient’s symptoms advance or worsen
  • Earlier intervention to be considered in asymptomatic patients with:
    • severe AS and left ventricular ejection fraction (LVEF) <55% without another cause (IIa)
    • severe AS and a sustained fall in blood pressure (>20 mmHg) during exercise testing (IIa)
    • LVEF >55% and a normal exercise test if the procedural risk is low and one of the following is present: very severe AS, severe valve calcification plus Vmax progression >0.3 m/s/year, or markedly elevated B-type natriuretic peptide levels without other explanation is present (IIa)2

The ESC/EACTS guidelines also support consideration of earlier intervention in select patients with asymptomatic aortic regurgitation.2

References

1. Strange G, Stewart S, Celermajer D et al. Poor long-term survival in patients with moderate aortic stenosis. JACC. 2019; 74: 1851–63.

2. Vahanian A, Beyersdorf F, Praz F et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2021.

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Dr. Alison Duncan

Be courageous, be experienced, be ethical … according to the Guidelines!

Dr. Alain Berrebi

MVT Aortic 2021

MVT Fundamentals Course

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MVT Fundamentals Course

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Dr. Jean-Louis Vanoverschelde, Belgium

Dr. Matthias Siepe, Germany 

Jean-Louis Vanoverschelde, Belgium