Valvular heart disease

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Editorial

Prevalence in Evidence: Valvular Heart Diseases Dominating the Brazilian Scenario

Valvular heart disease is a highly prevalent cardiovascular condition, estimated to affect more than 2% of the population, and is associated with increased mortality. However, most epidemiological studies are conducted in high-income countries, and we know that the characteristics vary according to the country and region of the world. In fact, degenerative valvular heart disease predominates in high-income countries, while rheumatic and infectious diseases are still very prevalent in lower-income countries. Socioeconomic conditions also have important implications for the diagnosis and treatment of this condition.

Data from the EURObservational Research Programme Valvular Heart Disease II (EORP-VHD II) Survey, with participants from 28 European countries and an average age of 71 years, reported aortic valve stenosis as the most frequent valvular disease, present in 41% of patients, followed at a distance by mitral regurgitation, aortic regurgitation, and mitral stenosis. Degenerative etiology was the most common, except for mitral stenosis, where rheumatic etiology predominated. This record reinforced the results of the initial EORP-VHD, conducted in 2001. The increase in aortic stenosis is likely a consequence of population aging, and the reduction in rheumatic mitral stenosis is a result of the decrease in rheumatic fever in Europe. Data recently published in the ATLAS of the European Society of Cardiology also highlight that valvular diseases continue to increase in prevalence and are responsible for thousands of deaths annually.

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Editorial

Beyond Atherosclerosis: Mind the Valves in Chronic Kidney Disease

Sofia Cabral

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among patients with chronic kidney disease (CKD), far surpassing the risk of progression to end-stage renal disease, and accounting for approximately 40% to 50% of all deaths in the advanced stages.^– Growing attention has been directed toward the intersection of renal dysfunction and valvular heart disease (VHD), which plays a major role in the cardiovascular complications and adverse outcomes observed in this population.^, Valvular calcification, particularly affecting the aortic and mitral valves, is the hallmark manifestation of VHD in this setting, representing a highly prevalent, progressive, and prognostically significant process driven by disordered mineral metabolism, its crosstalk with persistent inflammation, and the toxic uremic milieu.^, Despite growing acknowledgment of its clinical impact, the biological underpinnings remain incompletely understood, even as emerging evidence begins to clarify the processes driving valvular calcification in CKD.

While several mechanistic pathways have been identified, robust clinical and laboratory markers that predict its development remain elusive. In this regard, the study by Conceição et al. offers valuable insight into the factors associated with valvular calcification, helping to address a relevant blind spot in current knowledge and underscoring the need for continued research into its clinical implications and underlying mechanisms in this high-risk population. Their systematic review was based on twenty observational studies involving 13,314 patients from varied geographic contexts, including individuals both on and off dialysis. Most were cross-sectional in design, with fewer cohort studies and a single case-control study, reflecting the predominantly descriptive and observational nature of the available evidence. The breadth of the population analyzed, combined with the methodological rigor adopted, offers a comprehensive overview of the existing body of evidence in this still underexplored domain. Among the thirty-eight risk factors identified, advanced age (tipically above 55 years),was the most consistently associated with valvular calcification, reported in half of the studies reviewed. These findings lend further support to the concept that ageing represents a major determinant in valvular degeneration in CKD, as it does in the broader context of age-related valve disease in the general population.

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Original Article

Predictive Factors for Bleeding Risk in Patients Undergoing Valvular Surgery

Alef de Carvalho Vieira et al. Renato Tambellini Arnoni Ana Beatriz Silva Barbosa Attila Santos Berriel … Rafael Guimarães Vianna Mario Issa

Abstract

Background:

The postoperative period of heart valve surgery is challenging due to the risk of bleeding, leading to complications and increased morbidity and mortality.

Objective:

To develop a risk score to predict bleeding in patients after valve surgery.

Methods:

Retrospective study of patients operated on between 2021 and 2022. Patients with major bleeding were selected based on the BARC and Bojar criteria. A logistic regression analysis was performed for factors related to bleeding and a nomogram of scores was created. For statistical significance, p<0.05 and a 95% confidence interval were considered. The study was approved by the CEP.

Results:

525 patients were analyzed, with a mean age of 56 years and a predominance of females. The most common valve disease was mitral insufficiency, 8.8% had increased bleeding and 4.3% had surgical reoperations. The variables with statistical significance were tricuspid insufficiency (OR 3.31, p < 0.001), chronic kidney disease/acute kidney injury (OR 2.97, p = 0.006), preoperative hemoglobin (OR 0.73, p < 0.001), reoperations (OR 2, 5, p = 0.003), cardiopulmonary bypass (CPB) time (OR 1.12, p < 0.001), 2-valve approach OR of 2.23 (p = 0.013), use of packed red blood cells OR of 2.8 (p = 0.001). In the multiple model, tricuspid insufficiency, CPB time and preoperative hemoglobin reached statistical significance.

Conclusion:

CPB time, preoperative hemoglobin and tricuspid insufficiency were independently associated with postoperative bleeding. The proposed scale is plausible and can help predict the risk of bleeding.

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Review Article

Valvular Heart Disease Emergencies: A Comprehensive Review Focusing on the Initial Approach in the Emergency Department

Tarso Augusto Duenhas Accorsi et al. Milena Ribeiro Paixão José Leão de Souza Júnior Marcus Vinicius Burato Gaz … Ricardo Galesso Cardoso Karen Francine Köhler Karine De Amicis Lima Flavio Tarasoutchi INTEGRATE Investigadores

Abstract

Valvular heart disease (VHD) is an increasing health problem worldwide. Patients with VHD may experience several cardiovascular-related emergencies. The management of these patients is a challenge in the emergency department, especially when the previous heart condition is unknown. Specific recommendations for the initial management are currently poor. This integrative review proposes an evidence-based three-step approach from bedside VHD suspicion to the initial treatment of the emergencies. The first step is the suspicion of underlying valvular condition based on signs and symptoms. The second step comprises the attempt to confirm the diagnosis and assessment of VHD severity with complementary tests. Finally, the third step addresses the diagnosis and treatment options for heart failure, atrial fibrillation, valvular thrombosis, acute rheumatic fever, and infective endocarditis. In addition, several images of complementary tests and summary tables are provided for physician support.

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Prevalence in Evidence: Valvular Heart Diseases Dominating the Brazilian Scenario

Beyond Atherosclerosis: Mind the Valves in Chronic Kidney Disease

Predictive Factors for Bleeding Risk in Patients Undergoing Valvular Surgery

Abstract

Background:

Objective:

Methods:

Results:

Conclusion:

Valvular Heart Disease Emergencies: A Comprehensive Review Focusing on the Initial Approach in the Emergency Department

Abstract

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