Unmet needs in valvular heart disease

Messika–Zeitoun, David; Baumgartner, Helmut; Burwash, Ian G.; Vahanian, Alec; Bax, Jeroen J.; Chan, V.; Leon, Martin B.; Enríquez-Sarano, Maurice; Mesana, Thierry G.; Iung, Bernard

doi:10.1093/eurheartj/ehad121

Cited by 33 publications

(9 citation statements)

References 109 publications

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“… 15 In 2019, it was estimated that 9 million people had moderate-severe AS, a 17-fold increase in the prevalence over the last 30 years. 16 In the PARTNER trial when TAVR was initially examined, the mean age of the patients who could not undergo conventional cardiac surgery was 83 years. 17 Since then, the median age of patients in practice has been between 81 and 84 years.…”

Section: As In Older Adultsmentioning

confidence: 99%

TAVR in Older Adults

Damluji,

Bernacki,

Afilalo

et al. 2024

JACC: Advances

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Section: As In Older Adultsmentioning

confidence: 99%

TAVR in Older Adults

Damluji,

Bernacki,

Afilalo

et al. 2024

JACC: Advances

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“…149 In these VHD centres, the multidisciplinary VHD Heart Teams will evaluate the need, timing, and type of intervention. 16,150 Although, transcatheter TV replacement or repair represent novel and less invasive alternatives to surgery and have shown early promising results, larger randomized studies are needed to define the clinical and procedural endpoints and outcomes, in order to draw more solid conclusions, particularly for the subset of patients presenting with AHF. 151,152 .…”

Section: Tricuspid Regurgitationmentioning

confidence: 99%

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

Chioncel

Adamo

Nikolaou³

et al. 2023

European J of Heart Fail

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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.

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“…2,3 Despite the growing epidemic trend and significant disease burden, there are currently no recommended preventive measures effectively thwarting VHD. 4 Compelling evidence supports the role of physical activity in the prevention of atherosclerotic cardiovascular disease and related mortality. 5,6 A recent meta-analysis involving over 30 million participants from 94 prospective cohorts found that adhering to the World Health Organization (WHO) recommendation of 150 minutes per week of moderate-to-vigorous intensity physical activity (MVPA) was associated with a 21% lower risk of coronary heart disease.…”

Section: Introductionmentioning

confidence: 99%

Moderate-to-vigorous Intensity Physical Activity and Incident Left-sided Degenerative Valvular Heart Disease

Li,

Cheng,

Guo

et al. 2023

Preprint

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BackgroundDespite the escalating incidence of degenerative valvular heart disease (VHD), recommended preventive interventions are conspicuously absent. Physical activity has proven effective in preventing atherosclerotic cardiovascular disease, but its role in preventing VHD remains uncertain. This study aimed to explore the association between moderate-to-vigorous intensity physical activity (MVPA) and incident left-sided degenerative VHD in middle-aged adults from the UK biobank.MethodsData from wrist-worn accelerometer and self-reported questionnaires were utilized to assess the impact of MVPA volume on the incidence of aortic valve stenosis (AS), aortic valve regurgitation (AR), and mitral valve regurgitation (MR). Incident VHD were ascertained from hospital admissions and death reports. Cox proportional hazards regression models were employed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs), adjusted for sociodemographic characteristics, lifestyle risk factors, and comorbidities.ResultsIn the accelerometer-derived MVPA cohort (n=90,865; median age 63; 43% male; median follow-up 8.1 years), the age- and sex-adjusted incidence rates per 1000 person-years were 0.70 for AS, 0.29 for AR, and 0.84 for MR. In the questionnaire-based MVPA cohort (n=397,335; median age 57; 47% male; median follow-up 13.8 years), the corresponding rates were 0.76 for AS, 0.29 for AR, and 0.76 for MR. The accelerometer-measured MVPA volume showed a curvilinear relationship with reduced risk of AS, plateauing above 300 min/week. Participants engaging in 150-299 minutes of MVPA per week, meeting the guideline recommendation, had the most significant reduction in AS risk compared to those with no MVPA [adjusted HR, 0.53 (95% CI, 0.37-0.76)]. Similar results were found in the questionnaire-based MVPA cohort, with 150-299 minutes of MVPA showing a relatively smaller reduction in HR [adjusted HR, 0.82 (95% CI, 0.73-0.91)]. The association remained consistent across subgroups at high risk for AS. However, there was no significant inverse association of MVPA with risk of AR or MR.ConclusionAdhering to the recommended MVPA duration (150-299 min/week) was associated with the lowest risk of developing AS. Encouraging the utilization of wearable devices to monitor activity levels enhances AS risk reduction. Nonetheless, MVPA’s efficacy in preventing valvular regurgitation is limited, revealing distinctive pathological mechanisms in valvular stenotic and regurgitation lesions.Clinical PerspectiveWhat Is New?Engaging in 150-299 minutes of moderate-to-vigorous intensity physical activity per week can reduce the risk of aortic valve stenosis by nearly 50% in middle-aged individuals.Using wearable devices to measure activity levels may improve the risk stratification of aortic valve stenosis compared to assessments based on questionnaires.No significant association is observed between moderate-to-vigorous intensity physical activity and risks of aortic valve regurgitation and mitral valve regurgitation.What Are the Clinical Implications?Objective activity monitoring through wearable devices shows promise as an effective nonpharmaceutical intervention to alleviate the healthcare burdens associated with aortic valve stenosis.Encouraging middle-aged individuals at higher risk for aortic valve stenosis to engage in moderate volume (150-299 minutes per week) and moderate intensity physical activity (e.g., walking at a speed of 2.5 miles per hour) is recommended.Engaging in physical activity beyond the recommended volume and intensity does not yield additional benefits nor pose additional risks for aortic valve stenosis.

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Unmet needs in valvular heart disease

Cited by 33 publications

References 109 publications

TAVR in Older Adults

TAVR in Older Adults

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

Moderate-to-vigorous Intensity Physical Activity and Incident Left-sided Degenerative Valvular Heart Disease

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