Management of patients with severe aortic stenosis in the TAVI-era : How recent recommendations are translated into clinical practice
Lauten, Alexander (Department for Cardiology. Helios Clinic)
Rudolph, Tanja K. (Department of Cardiology. Hear and Diabetes Center Bad Oeynhausen. Ruhr-University of Bochum)
Messika-Zeitoun, David (University of Ottawa Heart Institute)
Thambyrajah, Jeetendra (James Cook University Hospital)
Serra, Antonio (Institut d'Investigació Biomèdica Sant Pau)
Schulz, Eberhard (Cardiology Department. Akh Celle)
Frey, Norbert (Department of Cardiology and Angiology. University of Kiel)
Maly, Jiri (Department of Cardiovascular Surgery. Second Faculty of Medicine. Charles University)
Aiello, Marco (Department of Cardiothoracic Surgery. Foundation Irccs Policlinico S.Matteo)
Lloyd, Guy (St Bartholomew's Hospital)
Bortone, Alessandro Santo (University of Bari)
Clerici, Alberto (University of Turin)
Delle-Karth, Georg (4th Medical Department. Hietzing Hospital)
Rieber, Johannes (Herzkatheterlabor Nymphenburg. Department of Cardiology. University of Munich)
Indolfi, Ciro (Division of Cardiology and Urt Cnr of Ifc. University Magna Graecia)
Mancone, Massimo (Sapienza University of Rome)
Belle, Loic (Centre Hospital d'Annecy)
Arnold, Martin (Department of Cardiology. University Hospital Erlangen)
Bouma, Berto J (University of Amsterdam)
Lutz, Matthias (University of Kiel. Department of Cardiology and Angiology)
Deutsch, Cornelia (Institut für Pharmakologie und Präventive Medizin GmbH)
Kurucova, Jana (Edwards Lifesciences)
Thoenes, Martin (Edwards Lifesciences)
Bramlage, Peter (Institut für Pharmakologie und Präventive Medizin GmbH)
Steeds, Richard (Queen Elizabeth Hospital. Institute of Cardiovascular Sciences. University of Birmingham)

Data:	2021
Resum:	Objective Approximately 3. 4% of adults aged >75 years suffer from aortic stenosis (AS). Guideline indications for aortic valve replacement (AVR) distinguish between patients with symptomatic and asymptomatic severe AS. The present analysis aims to assess contemporary practice in the treatment of severe AS across Europe and identify characteristics associated with treatment decisions, namely denial of AVR in symptomatic patients and assignment of asymptomatic patients to AVR. Methods Participants of the prospective, multinational IMPULSE database of patients with severe AS were grouped according to AS symptoms, and stratified into subgroups based on assignment to/denial of AVR. Results Of 1608 symptomatic patients, 23. 8% did not undergo AVR and underwent medical treatment. Denial was independently associated with multiple factors, including severe frailty (p=0. 024); mitral (p=0. 002) or tricuspid (p=0. 004) regurgitation grade III/IV, and the presence of renal impairment (p=0. 017). Of 392 asymptomatic patients, 86. 5% had no prespecified indication for AVR. Regardless, 36. 3% were assigned to valve replacement. Those with an indexed aortic valve area (AVA; p=0. 045) or left ventricular ejection fraction (LVEF; p<0. 001) below the study median; or with a left ventricular end systolic diameter above the study median (p=0. 007) were more likely to be assigned to AVR. Conclusions There may be considerable discrepancies between guideline-based recommendations and clinical practice decision-making in the treatment of AS. It appears that guidelines may not fully capture the complete clinical spectrum of patients with AS. Thus, there is a need to find ways to increase their acceptance and the rate of adoption.
Nota:	Altres ajuts: Edwards Lifesciences (Nyon, Switzerland).
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	Open Heart, Vol. 8 Núm. 1 (november 2021) , p. e001485, ISSN 2053-3624

DOI: 10.1136/openhrt-2020-001485
PMID: 33431618

11 p, 1.9 MB

El registre apareix a les col·leccions:
Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut de Recerca Sant Pau
Articles > Articles de recerca
Articles > Articles publicats