Actual management of patients with asymptomatic aortic valve disease: how practice fits with guidelines.
BACKGROUND
Intervention is advised in selected asymptomatic patients with aortic valve disease. However, little is known regarding their actual management.


METHODS
The Euro Heart Survey was designed to evaluate practices. Severe isolated aortic stenosis (AS) was defined by a valve area < or = 0.6 cm2/m2 body surface area or mean gradient > or = 50 mm Hg. Severe aortic regurgitation (AR) was defined by a grade > or = 3/4. Patients were classified as asymptomatic when they were in New York Heart Association class I and were without angina. Decision to operate was analyzed by comparing patient characteristics with the American College of Cardiology/American Heart Association recommendations.


RESULTS
Of the 5001 patients, 136 had severe, isolated, and asymptomatic aortic valve disease (84 with AS and 52 with AR). Stress testing was performed in only 6 patients (4%). A decision to operate was taken in 45 patients (54%) with AS and 21 (40%) with AR. Indications for surgery were in accordance with the American College of Cardiology/American Heart Association guidelines in 57 patients (68%) with AS and in 41 (83%) with AR. However, the decision to operate was frequently based on class IIb recommendations in patients with AS. Intervention was "overused" in 18 patients with AS (21%) and in 5 (9%) with AR. Intervention was "underused" in 9 patients (11%) with AS and in 4 (8%) with AR.


CONCLUSIONS
In asymptomatic patients with severe aortic valve disease, a decision to operate is frequently taken; and it is most often in agreement with guidelines, although often based on low-level recommendations.
Iung
Bernard
B
Cardiology Department, Bichat Hospital, AP-HP, Paris, France. bernard.iung@bch.aphp.fr
Messika-Zeitoun
David
D
Cachier
Agnès
A
Delahaye
François
F
Baron
Gabriel
G
Tornos
Pilar
P
Gohlke-Bärwolf
Christa
C
Boersma
Eric
E
Ravaud
Philippe
P
Vahanian
Alec
A
D000368:Aged; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies