Valvular Heart Disease ESC

Question 1

Coronary angiography is recommended in:
Hx of CV disease
≥ 1 CV risk factors
Male > 40 yo, postmenopausal female
Suspected Myocardial ischemia
LV systolic dysfunction

Answer 1

I. C.

Question 2

Coronary angiography recommended in moderate to severe secondary MR.

Answer 2

I. C.

Question 3

CT angiography should be considered in severe VHD and low probability of CAD or in whom high risk of CA.

Answer 3

IIa. C

Question 4

Intervention is indicated in symptomatic patients with severe, high-gradient aortic stenosis (mean gradient >_40 mmHg or peak velocity >_4.0 m/s).

Answer 4

I. B.
No large randomized trials. But based on large cohorts.
Based on real world outcomes of surgical aortic valve replacement. Better outcome than predicted.
Also Partner high risk good survival.

Question 5

Intervention is indicated in symptomatic patients with severe low-flow, low-gradient (<40 mmHg) aortic stenosis with reduced ejection fraction and evidence of flow (contractile) reserve excluding pseudosevere aortic stenosis.
D2 from AHA

Answer 5

I. C
Based on Therapy study. Cuasiexperimental study by Jean Monin in severe aortic stenosis with low gradient low cardiac index ≤ 3.0. Mean LVEF 30%, predictors of survival:
AVR. HR: 0.30 (0.17 - 0.53)
LV contractile reserve (≥ 20% SV increase with DBT 20 ug/kg/min). HR: 0.40 (0.23 - 0.69)
Predictors of mortality:
Lack of contractile reserve. HR: 10.9 (2.6 - 43.4)
Mean Transaortic gradient ≤ 20 mm Hg. HR: 4.7 (1.1 - 21.0)

Question 6

Intervention should be considered in symptomatic patients with low-flow, low-gradient aortic stenosis and reduced ejection fraction without flow (contractile) reserve, particularly when CT calcium scoring confirms severe aortic stenosis.

Answer 6

IIa. C.
Based on studies by Jean Monin, better outcome with surgical than medical treatment.
Based on Therapy Study from Christophe Tribouilloy that studied 81 pts with LG LFAS with LVEF ≤40% without contractile reserve.
Lower 5 years survival with AVR.

Based on Levy study from report from 217 patients.

Based on
on calcium scoring that predicts severe AS.

Question 7

Intervention should be considered in symptomatic patients with low-flow, low-gradient (<40 mmHg) aortic stenosis with normal ejection fraction after careful confirmation of severe aortic stenosis.

Answer 7

IIa. C

Based on 2 studies, same prognosis as Moderate AS, 1 study suggests worse prognosis than SAS.

Question 8

Intervention should not be performed in patients with severe comorbidities when the intervention is unlikely to improve quality of life or survival.

Answer 8

III. C.

Survival less than 1 year.