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.

Objective:The aim of the present study was to evaluate left atrial (LA) volume and functions using real-time three-dimensional echocardiography (RT3DE) and speckle tracking in systemic sclerosis (SSc) patients.Methods:The study was designed as a cross-sectional observational study. We studied 41 consecutive SSc patients (38 females, mean age: 49.5±11.6 years) and 38 healthy controls (35 females, mean age: 48.5±10.8 years). Patients with evidence or history of cardiovascular disease and patients with risk factors as hypertension, diabetes and chronic renal failure were excluded from the study. All study subjects underwent standard echocardiography; LA speckle tracking and RT3DE was performed to assess LA volume and phasic functions. Differences between numeric variables were tested using the independent sample Student’s t-test or Mann-Whitney U test, where appropriate.Results:There were no significant differences between SSC patients and controls regarding left ventricular (LV) systolic functions and two-dimensional (2-D) atrial diameters. Presence of LV diastolic dysfunction (LVDD) was evaluated and graded according to recommendations of the American Society of Echocardiography. Accordingly, LVDD was observed to be significantly more frequent in SSc patients; 16 SSc patients (39%) and 5 controls (12.8%) were observed to have LVDD (p=0.007). With regard to results obtained from RT3DE, LA maximum, minimum, and before atrial contraction volumes were significantly higher (40.5±14.6 vs. 32.6±8.9, 15.5±8.4 vs. 9.9±3.5 and 28.7±11.7 vs. 21.4±7.0 mL respectively, p<0.05 for all), whereas LA active emptying fraction, LA total emptying fraction, LA expansion index, and passive emptying fraction values were significantly (47.1±12.0 vs. 52.9±10.1%, 62.8±10.5 vs. 69.5±6.7%, 187.5±76.0 vs. 246.6±96.0, 29.6±9.3 vs. 34.4±11.0% respectively, p<0.05 for all) in SSc patients than in controls. In addition, regarding results obtained from speckle tracking echocardiography, atrial peak-systolic longitudinal strain (e), early negative strain rate (SR), late negative SR, and peak positive SR values were observed to be significantly lower in SSc patients.Conclusion:LA volumes were significantly increased, and LA reservoir, conduit, and contractile functions were significantly impaired in SSc patients compared with controls. LA volume and functional analyses with RT3DE and speckle tracking may facilitate the recognition of subtle LA dysfunction in SSc patients.

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Koroner arter hastalığı olan hastalarda anksiyete ve depresyon Amaç: Önceki prospektif çalışmalarda depresyonun miyokardiyal enfarktüs ve kardiyovasküler mortalite için bağımsız bir risk faktörü olduğu bildirilmiştir. Anksiyete bozukluklarının da koroner arter hastalığı (KAH) ile ilişkili olduğu bilinmektedir. Psikolojik faktörler de sigara içme, azalmış fiziksel aktivite, kötü diyet ve tedaviye uyumun azalması gibi davranışsal mekanizmalar ile KAH seyrini etkileyebilmektedir. Bu çalışmanın amacı KAH şüphesiyle elektif olarak koroner anjiyografi yapılmak üzere kabul edilmiş hastalarda anksiyete ve depresyon düzeylerini araştırmak ve aterosklerotik risk faktörlerini saptamaktır. Yöntem: Çalışma örneklemi ardışık olarak elektif koroner anjiyografi yapılan 116 hastadan oluşmuştur. Bulgular iki majör grup olarak sınıflandırıldı: normal ve anormal koroner anjiyografi. Koroner arterlerinde aterosklerotik hastalık saptanan (%50 ya da daha fazla darlık) ve/veya koroner arterlerinde yavaş kan akımı olan hastaların anjiyografileri anormal olarak değerlendirilmiştir. Hastaların anksiyete ve depresyon düzeyleri özbildirime dayalı Beck Depresyon Envanteri, Beck Anksiyete Envanteri ve Spielberger'in Durumluluk-Süreklilik Anksiyete Envanteri kullanılarak ölçülmüştür. Bulgular: Altmışüç hastada (44 erkek, ortalama yaş: 52.2±11.1 yıl) anormal koroner anjiyografi bulgusu saptanmışken elli üç hastanın (40 erkek, ortalama yaş: 54.5±10.5 yıl) anjiyografisi normal olarak değerlendirilmiştir. Sosyodemografik özellikler ve aterosklerotik risk faktörleri her iki grupta benzerdi. Anormal koroner anjiyografi bulguları saptanan hastalar, normal bulgular saptanan hastalarla karşılaştırıldığında, anlamlı olarak daha yüksek depresyon ve anksiyete düzeylerine sahipti. Logistik regresyon analizinde sadece Beck Anksiyete Envanteri skorunun 15'den daha yüksek (odds ratio: 13.2, CI: 3.8-46.4) ve Durumluluk Anksiyete Envanteri skorunun 42'den yüksek olması (odds ratio: 4.9, CI: 1.7-14.2) koroner arter hastalığı için bağımsız belirleyicisidir. Sonuç: Her iki grup için kardiyovasküler risk faktörleri benzer iken koroner arter hastalığı ile depresyon ve anksiyete düzeyleri arasında anlamlı bir ilişkinin olabileceği gösterilmiştir.