Interpretation of the <i>2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease</i>_West China Medical Journal

Authors：

WANG Bin , YANG Jie ,  WANG Yan

Department of Structural Heart Disease, Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, Fujian 361000, P. R. China;

Corresponding author：

WANG Yan, Email: wy@medmail.com.cn

Keywords：

Guideline interpretation; Valvular heart disease; Management

DOI：

10.7507/1002-0179.202108248

Video：

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The 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease not only updates aortic valve stenosis, mitral regurgitation, prosthetic valves, infective endocarditis and antithrombotic treatment on the basis of the 2017 guidelines update for valvular heart disease, but also involves aortic valve regurgitation, bicuspid aortic valve, mitral stenosis, tricuspid regurgitation, combined valve disease, pregnancy with valvular disease, valve disease complicated with coronary heart disease, valve disease complicated with non-cardiac surgery and the prospect of comprehensive management of valve disease. It covers a wide range of contents, which are introduced in detail and comprehensively. This paper interprets some highlights and core issues, including the top 10 take-home messages, the severity of valvular heart disease, and the updates in the management of aortic valve stenosis, aortic valve regurgitation, bicuspid aortic valve, mitral stenosis and mitral regurgitation.

Citation： WANG Bin, YANG Jie, WANG Yan. Interpretation of the 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease. West China Medical Journal, 2021, 36(9): 1184-1190. doi: 10.7507/1002-0179.202108248 Copy

1.	Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2020, 77(4): 450-500.
2.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
3.	Baumgartner H, Hung J, Bermejo J, et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr, 2017, 30(4): 372-392.
4.	Gardezi SKM, Myerson SG, Chambers J, et al. Cardiac auscultation poorly predicts the presence of valvular heart disease in asymptomatic primary care patients. Heart, 2018, 104(22): 1832-1835.
5.	Lin SS, Roger VL, Pascoe R, et al. Dobutamine stress Doppler hemodynamics in patients with aortic stenosis: feasibility, safety, and surgical correlations. Am Heart J, 1998, 136(6): 1010-1016.
6.	Monin JL, Monchi M, Gest V, et al. Aortic stenosis with severe left ventricular dysfunction and low transvalvular pressure gradients: risk stratification by low-dose dobutamine echocardiography. J Am Coll Cardiol, 2001, 37(8): 2101-2107.
7.	Oh JK, Taliercio CP, Holmes DJ, et al. Prediction of the severity of aortic stenosis by Doppler aortic valve area determination: prospective Doppler-catheterization correlation in 100 patients. J Am Coll Cardiol, 1988, 11(6): 1227-1234.
8.	Jander N, Hochholzer W, Kaufmann BA, et al. Velocity ratio predicts outcomes in patients with low gradient severe aortic stenosis and preserved EF. Heart, 2014, 100(24): 1946-1953.
9.	Pawade T, Clavel MA, Tribouilloy C, et al. Computed tomography aortic valve calcium scoring in patients with aortic stenosis. Circ Cardiovasc Imaging, 2018, 11(3): e007146.
10.	Rosenhek R, Binder T, Porenta G, et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med, 2000, 343(9): 611-617.
11.	Nazarzadeh M, Pinho-Gomes AC, Smith BK, et al. Systolic blood pressure and risk of valvular heart disease: a mendelian randomization study. JAMA Cardiol, 2019, 4(8): 788-795.
12.	Rahimi K, Mohseni H, Kiran A, et al. Elevated blood pressure and risk of aortic valve disease: a cohort analysis of 5.4 million UK adults. Eur Heart J, 2018, 39(39): 3596-3603.
13.	Nielsen OW, Sajadieh A, Sabbah M, et al. Assessing optimal blood pressure in patients with asymptomatic aortic valve stenosis: the Simvastatin Ezetimibe in Aortic Stenosis study (SEAS). Circulation, 2016, 134(7): 455-468.
14.	Rossebo AB, Pedersen TR, Boman K, et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med, 2008, 359(13): 1343-1356.
15.	Patel PA, Bavaria JE, Ghadimi K, et al. Aortic regurgitation in acute type-A aortic dissection: a clinical classifification for the perioperative echocardiographer in the era of the functional aortic annulus. J Cardiothorac Vasc Anesth, 2018, 32(8): 586-597.
16.	Hamirani YS, Dietl CA, Voyles W, et al. Acute aortic regurgitation. Circulation, 2012, 126(9): 1121-1126.
17.	Trost JC, Hillis LD. Intra-aortic balloon counterpulsation. Am J Cardiol, 2006, 97(9): 1391-1398.
18.	Elder DH, Wei L, Szwejkowski BR, et al. The impact of renin-angiotensin-aldosterone system blockade on heart failure outcomes and mortality in patients identified to have aortic regurgitation: a large population cohort study. J Am Coll Cardiol, 2011, 58(20): 2084-2091.
19.	Sampat U, Varadarajan P, Turk R, et al. Effect of beta-blocker therapy on survival in patients with severe aortic regurgitation results from a cohort of 756 patients. J Am Coll Cardiol, 2009, 54(5): 452-457.
20.	Sawaya FJ, Deutsch MA, Seiffert M, et al. Safety and effificacy of transcatheter aortic valve replacement in the treatment of pure aortic regurgitation in native valves and failing surgical bioprostheses: results from an International Registry Study. JACC Cardiovasc Interv, 2017, 10(6): 1048-1056.
21.	Jiang J, Liu X, He Y, et al. Transcatheter aortic valve replacement for pure native aortic valve regurgitation: a systematic review. Cardiology, 2018, 141(3): 132-140.
22.	Masri A, Svensson LG, Griffin BP, et al. Contemporary natural history of bicuspid aortic valve disease: a systematic review. Heart, 2017, 103(17): 1323-1330.
23.	Nunes MCP, Tan TC, Elmariah S, et al. Net atrioventricular compliance is an independent predictor of cardiovascular death in mitral stenosis. Heart, 2017, 103(23): 1891-1898.
24.	Bertrand PB, Mihos CG, Yucel E. Mitral annular calcification and calcific mitral stenosis: therapeutic challenges and considerations. Curr Treat Options Cardiovasc Med, 2019, 21(4): 19.
25.	Guerrero M, Urena M, Himbert D, et al. 1-year outcomes of transcatheter mitral valve replacement in patients with severe mitral annular calcification. J Am Coll Cardiol, 2018, 71(17): 1841-1853.
26.	Nanjappa MC, Ananthakrishna R, Hemanna SS, et al. Acute severe mitral regurgitation following balloon mitral valvotomy: echocardiographic features, operative findings, and outcome in 50 surgical cases. Catheter Cardiovasc Interv, 2013, 81(4): 603-608.
27.	Watanabe N. Acute mitral regurgitation. Heart, 2019, 105(9): 671-677.
28.	Pillai AA, Balasubramonian VR, Munuswamy H, et al. Acute severe mitral regurgitation with cardiogenic shock following balloon mitral valvuloplasty: echocardiographic findings and outcomes following surgery. Cardiovasc Interv Ther, 2019, 34(3): 260-268.
29.	David TE, David CM, Tsang W, et al. Long-term results of mitral valve repair for regurgitation due to leaflet prolapse. J Am Coll Cardiol, 2019, 74(8): 1044-1053.
30.	Sorajja P, Vemulapalli S, Feldman T, et al. Outcomes with transcatheter mitral valve repair in the United States: an STS/ACC TVT registry report. J Am Coll Cardiol, 2017, 70(19): 2315-2327.
31.	Michler RE, Smith PK, Parides MK, et al. Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med, 2016, 374(20): 1932-1941.
32.	Goldstein D, Moskowitz AJ, Gelijns AC, et al. Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation. N Engl J Med, 2016, 374(4): 344-353.
33.	Grayburn PA, Carabello B, Hung J, et al. Defining “severe” secondary mitral regurgitation: emphasizing an integrated approach. J Am Coll Cardiol, 2014, 64(25): 2792-2801.
34.	Stone GW, Lindenfeld J, Abraham WT, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med, 2018, 379(24): 2307-2318.
35.	Obadia JF, Messika-Zeitoun D, Leurent G, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med, 2018, 379(24): 2297-2306.

1. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol, 2020, 77(4): 450-500.
2. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
3. Baumgartner H, Hung J, Bermejo J, et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr, 2017, 30(4): 372-392.
4. Gardezi SKM, Myerson SG, Chambers J, et al. Cardiac auscultation poorly predicts the presence of valvular heart disease in asymptomatic primary care patients. Heart, 2018, 104(22): 1832-1835.
5. Lin SS, Roger VL, Pascoe R, et al. Dobutamine stress Doppler hemodynamics in patients with aortic stenosis: feasibility, safety, and surgical correlations. Am Heart J, 1998, 136(6): 1010-1016.
6. Monin JL, Monchi M, Gest V, et al. Aortic stenosis with severe left ventricular dysfunction and low transvalvular pressure gradients: risk stratification by low-dose dobutamine echocardiography. J Am Coll Cardiol, 2001, 37(8): 2101-2107.
7. Oh JK, Taliercio CP, Holmes DJ, et al. Prediction of the severity of aortic stenosis by Doppler aortic valve area determination: prospective Doppler-catheterization correlation in 100 patients. J Am Coll Cardiol, 1988, 11(6): 1227-1234.
8. Jander N, Hochholzer W, Kaufmann BA, et al. Velocity ratio predicts outcomes in patients with low gradient severe aortic stenosis and preserved EF. Heart, 2014, 100(24): 1946-1953.
9. Pawade T, Clavel MA, Tribouilloy C, et al. Computed tomography aortic valve calcium scoring in patients with aortic stenosis. Circ Cardiovasc Imaging, 2018, 11(3): e007146.
10. Rosenhek R, Binder T, Porenta G, et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med, 2000, 343(9): 611-617.
11. Nazarzadeh M, Pinho-Gomes AC, Smith BK, et al. Systolic blood pressure and risk of valvular heart disease: a mendelian randomization study. JAMA Cardiol, 2019, 4(8): 788-795.
12. Rahimi K, Mohseni H, Kiran A, et al. Elevated blood pressure and risk of aortic valve disease: a cohort analysis of 5.4 million UK adults. Eur Heart J, 2018, 39(39): 3596-3603.
13. Nielsen OW, Sajadieh A, Sabbah M, et al. Assessing optimal blood pressure in patients with asymptomatic aortic valve stenosis: the Simvastatin Ezetimibe in Aortic Stenosis study (SEAS). Circulation, 2016, 134(7): 455-468.
14. Rossebo AB, Pedersen TR, Boman K, et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med, 2008, 359(13): 1343-1356.
15. Patel PA, Bavaria JE, Ghadimi K, et al. Aortic regurgitation in acute type-A aortic dissection: a clinical classifification for the perioperative echocardiographer in the era of the functional aortic annulus. J Cardiothorac Vasc Anesth, 2018, 32(8): 586-597.
16. Hamirani YS, Dietl CA, Voyles W, et al. Acute aortic regurgitation. Circulation, 2012, 126(9): 1121-1126.
17. Trost JC, Hillis LD. Intra-aortic balloon counterpulsation. Am J Cardiol, 2006, 97(9): 1391-1398.
18. Elder DH, Wei L, Szwejkowski BR, et al. The impact of renin-angiotensin-aldosterone system blockade on heart failure outcomes and mortality in patients identified to have aortic regurgitation: a large population cohort study. J Am Coll Cardiol, 2011, 58(20): 2084-2091.
19. Sampat U, Varadarajan P, Turk R, et al. Effect of beta-blocker therapy on survival in patients with severe aortic regurgitation results from a cohort of 756 patients. J Am Coll Cardiol, 2009, 54(5): 452-457.
20. Sawaya FJ, Deutsch MA, Seiffert M, et al. Safety and effificacy of transcatheter aortic valve replacement in the treatment of pure aortic regurgitation in native valves and failing surgical bioprostheses: results from an International Registry Study. JACC Cardiovasc Interv, 2017, 10(6): 1048-1056.
21. Jiang J, Liu X, He Y, et al. Transcatheter aortic valve replacement for pure native aortic valve regurgitation: a systematic review. Cardiology, 2018, 141(3): 132-140.
22. Masri A, Svensson LG, Griffin BP, et al. Contemporary natural history of bicuspid aortic valve disease: a systematic review. Heart, 2017, 103(17): 1323-1330.
23. Nunes MCP, Tan TC, Elmariah S, et al. Net atrioventricular compliance is an independent predictor of cardiovascular death in mitral stenosis. Heart, 2017, 103(23): 1891-1898.
24. Bertrand PB, Mihos CG, Yucel E. Mitral annular calcification and calcific mitral stenosis: therapeutic challenges and considerations. Curr Treat Options Cardiovasc Med, 2019, 21(4): 19.
25. Guerrero M, Urena M, Himbert D, et al. 1-year outcomes of transcatheter mitral valve replacement in patients with severe mitral annular calcification. J Am Coll Cardiol, 2018, 71(17): 1841-1853.
26. Nanjappa MC, Ananthakrishna R, Hemanna SS, et al. Acute severe mitral regurgitation following balloon mitral valvotomy: echocardiographic features, operative findings, and outcome in 50 surgical cases. Catheter Cardiovasc Interv, 2013, 81(4): 603-608.
27. Watanabe N. Acute mitral regurgitation. Heart, 2019, 105(9): 671-677.
28. Pillai AA, Balasubramonian VR, Munuswamy H, et al. Acute severe mitral regurgitation with cardiogenic shock following balloon mitral valvuloplasty: echocardiographic findings and outcomes following surgery. Cardiovasc Interv Ther, 2019, 34(3): 260-268.
29. David TE, David CM, Tsang W, et al. Long-term results of mitral valve repair for regurgitation due to leaflet prolapse. J Am Coll Cardiol, 2019, 74(8): 1044-1053.
30. Sorajja P, Vemulapalli S, Feldman T, et al. Outcomes with transcatheter mitral valve repair in the United States: an STS/ACC TVT registry report. J Am Coll Cardiol, 2017, 70(19): 2315-2327.
31. Michler RE, Smith PK, Parides MK, et al. Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med, 2016, 374(20): 1932-1941.
32. Goldstein D, Moskowitz AJ, Gelijns AC, et al. Two-year outcomes of surgical treatment of severe ischemic mitral regurgitation. N Engl J Med, 2016, 374(4): 344-353.
33. Grayburn PA, Carabello B, Hung J, et al. Defining “severe” secondary mitral regurgitation: emphasizing an integrated approach. J Am Coll Cardiol, 2014, 64(25): 2792-2801.
34. Stone GW, Lindenfeld J, Abraham WT, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med, 2018, 379(24): 2307-2318.
35. Obadia JF, Messika-Zeitoun D, Leurent G, et al. Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med, 2018, 379(24): 2297-2306.

West China Medical Journal

Interpretation of the 2020 ACC/AHA Guideline for the Management of Patients with Valvular Heart Disease

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