European survey on valvular heart disease clinical experience from the European Society of Cardiology council on valvular heart disease

Anna Sannino; Sarah Campbell; Julia Grapsa; Thomas Modine; Marco Barbanti; John B Chambers; Jose L Zamorano; Philippe Pibarot; Madalina Garbi; Mani Vannan; Gilbert Habib; Patrizio Lancellotti

doi:10.1093/ehjopen/oeac054

European survey on valvular heart disease clinical experience from the European Society of Cardiology council on valvular heart disease

Eur Heart J Open. 2022 Sep 2;2(5):oeac054. doi: 10.1093/ehjopen/oeac054. eCollection 2022 Sep.

Authors

Affiliations

¹ Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
² Department of Cardiology, Guys and St Thomas NHS Trust, London, United Kingdom.
³ Service Médico-Chirurgical, Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, Bordeaux, France.
⁴ Ferrarotto Hospital, University of Catania, Catania, Italy.
⁵ Department of Cardiology, Hospital Universitario Ramón y Cajal, M-607, 9, 100, 28034 Madrid, Spain.
⁶ Institut de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada.
⁷ Department of Cardiology, Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, UK.
⁸ Piedmont Heart Institute, Atlanta, Georgia.
⁹ Cardiology Department, AP-HM, La Timone Hospital, Marseille, France.
¹⁰ Cardiology Department, University Hospital Centre, Centre Hospitalier Universitaire (CHU) Sart Tilman, Liège, Belgium.

Abstract

Aims: The aim of this survey is to analyze how current recommendations on valvular heart disease (VHD) management have been adopted. Identifying potential discrepancies between recommendations and everyday clinical practice would enable us to better understand and address the remaining challenges in this controversial and complex field.

Methods and results: A total of 33 questions, distributed via email to all European Society of Cardiology (ESC) affiliated countries through the newsletter of the ESC council on VHD, were answered by 689 respondents, mainly from tertiary care settings. The results of this survey showed that VHD patients are mostly managed by tertiary care centres, where multi-disciplinary heart teams are frequently a reality. Cardiac computed tomography (CT) is often used in the preprocedural planning of transcatheter interventions, particularly for sizing and deliverability assessment. Echocardiography represents the most widely used imaging modality in the diagnostic, intra-operative and follow-up phase of VHD patients. Cardiac magnetic resonance (CMR) is still largely underused, also for conditions such as mitral annular disjunction, or for the assessment of left ventricle volumes where it is considered as the gold standard, despite 3D volumes by echocardiography having proved good comparability with CMR. As for endocarditis, despite still underused, transesophageal echocardiography (TEE) represents the approach of choice for the diagnosis of native and prosthesis valve endocarditis (up to 46% of the respondents use it). In this context, positron emission tomography-CT is largely underused.

Conclusion: There is widespread adoption of current recommendation on the evaluation of VHD and these are frequently used to guide patient management. Nonetheless, there are still many discrepancies across centres and countries which need to be addressed with the aim of improving patients' management and outcomes and ultimately positively impacting on healthcare resources.

Keywords: Clinics; Survey; Valvular.