Heartbeat: Focus on valvular heart disease

We have seen a recent upsurge in research related to valvular heart disease due to increasing recognition of the prevalence and adverse outcomes associated with heart valve disease, improved imaging modalities allowing early diagnosis and sequential evaluation, and new treatment options which offer the promise of reduced symptoms and longer survival in patients with these conditions. Valve disease research includes a spectrum of methodological approaches including basic science to understand disease mechanism and identify potential therapeutic targets, epidemiological studies to estimate prevalence and determine modifiable risk factors, imaging studies to improve diagnosis and quantitation of disease severity, clinical studies to better understand the pathophysiology and disease course, and interventional studies to evaluate the efficacy of surgical and transcatheter valve procedures. In this issue of Heart , we present a few of the recent interesting clinical studies of outcomes in patients with valvular heart disease. These papers highlight the challenges of clinical research in patients with valvular heart disease and suggest a path forward using advanced imaging to study disease mechanisms as well as larger datasets to study clinical outcomes, even in subset of patients with less common types or combinations of valve disease. The effect of anticoagulation on valve haemodynamics after transcatheter valve replacement (TAVR) was examined in a multicentre study of 2466 patients (46% men, mean age of 81 years).1 A propensity score matched analysis with 622 patients in each group suggested that the absence of treatment with anticoagulation after TAVR was associated with a significant increase in transvalvular gradient over 29±18 months of follow-up. In contrast, those receiving anticoagulation had no change in gradient over time and had a lower incidence of haemodynamic deterioration (0.6% vs 3.9%, p<0.001). However, a transvalvular …