Both the US and European valve guidelines focus on the need for mechanical intervention
in severe valvular heart disease (VHD) where intervention may be life saving.
1
,2
Indeed, mechanical intervention is recommended in almost all cases of severe symptomatic
disease and in asymptomatic patients with ventricular dysfunction. There are also
many class 2 indications for intervention, even in severe asymptomatic disease with
“normal” ventricular function. Given that our definitions of mild, moderate, and severe
disease are primarily based on the association of outcome with that degree of severity,
some patients simply do not obey the rules. Some patients with “severe” disease defy
our recommendations and do well anyway, whereas others with “moderate” disease do
poorly. In this latter group, it is likely that, for those patients, the disease has
the outcome of “severe,” although our man-made definition miscategorizes their disease
as merely moderate.
3
,4
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References
- 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2021; 143: e72-e227
- 2017 ESC/EACTS guidelines for the management of valvular heart disease.Eur Heart J. 2017; 38: 2739-2791
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- Moderate aortic stenosis in patients with heart failure and reduced ejection fraction.J Am Coll Cardiol. 2021; 77: 2796-2803
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- Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure.Am J Cardiol. 2003; 91: 538-543
- Independent prognostic value of functional mitral regurgitation in patients with heart failure: a quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy.Heart. 2011; 97: 1675-1680
- Normal myocardial function in severe right ventricular volume overload hypertrophy.Am J Physiol Heart Circ Physiol. 2001; 280: H11-H16
- Long-term outcome of active surveillance in severe but asymptomatic primary mitral regurgitation.JACC Cardiovasc Imaging. 2018; 11: 1213-1221
- Chronic mitral regurgitation and aortic regurgitation: have indications for surgery changed?.J Am Coll Cardiol. 2013; 61: 693-701
- Impact of tricuspid regurgitation on long-term survival.J Am Coll Cardiol. 2004; 43: 405-409
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Article info
Publication history
Published online: July 20, 2021
Accepted:
July 13,
2021
Received:
June 29,
2021
Footnotes
See article by Mori et al., pages 1513-1521 of this issue.
See page 1499 for disclosure information.
Identification
Copyright
© 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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- Survival of Patients With Mild Secondary Mitral Regurgitation With and Without Mild Tricuspid RegurgitationCanadian Journal of CardiologyVol. 37Issue 10
