Acute heart failure and valvular heart disease: A scientific statement of the Heart Failure Association, the Association for Acute CardioVascular Care and the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology

Chioncel O. Adamo M. Nikolaou M. Parissis J. Mebazaa A. Yilmaz M.B. Hassager C. Moura B. Bauersachs J. Harjola V.-P. Antohi E.-L. Ben-Gal T. Collins S.P. Iliescu V.A. Abdelhamid M. Čelutkienė J. Adamopoulos S. Lund L.H. Cicoira M. Masip J. Skouri H. Gustafsson F. Rakisheva A. Ahrens I. Mortara A. Janowska E.A. Almaghraby A. Damman K. Miro O. Huber K. Ristic A. Hill L. Mullens W. Chieffo A. Bartunek J. Paolisso P. Bayes-Genis A. Anker S.D. Price S. Filippatos G. Ruschitzka F. Seferovic P. Vidal-Perez R. Vahanian A. Metra M. McDonagh T.A. Barbato E. Coats A.J.S. Rosano G.M.C.
July 2023 John Wiley and Sons Ltd

European Journal of Heart Failure
2023 #25 Issue 7 1025 - 1048 pp.

Acute heart failure (AHF) represents a broad spectrum of disease states, resulting from the interaction between an acute precipitant and a patients underlying cardiac substrate and comorbidities. Valvular heart disease (VHD) is frequently associated with AHF. AHF may result from several precipitants that add an acute haemodynamic stress superimposed on a chronic valvular lesion or may occur as a consequence of a new significant valvular lesion. Regardless of the mechanism, clinical presentation may vary from acute decompensated heart failure to cardiogenic shock. Assessing the severity of VHD as well as the correlation between VHD severity and symptoms may be difficult in patients with AHF because of the rapid variation in loading conditions, concomitant destabilization of the associated comorbidities and the presence of combined valvular lesions. Evidence-based interventions targeting VHD in settings of AHF have yet to be identified, as patients with severe VHD are often excluded from randomized trials in AHF, so results from these trials do not generalize to those with VHD. Furthermore, there are not rigorously conducted randomized controlled trials in the setting of VHD and AHF, most of the data coming from observational studies. Thus, distinct to chronic settings, current guidelines are very elusive when patients with severe VHD present with AHF, and a clear-cut strategy could not be yet defined. Given the paucity of evidence in this subset of AHF patients, the aim of this scientific statement is to describe the epidemiology, pathophysiology, and overall treatment approach for patients with VHD who present with AHF.

Acute heart failure , Management , Valvular heart disease

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Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’, Bucharest, Romania
University of Medicine Carol Davila, Bucharest, Romania
Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
Cardiology Department, General Hospital Sismanogleio-Amalia Fleming, Athens, Greece
Heart Failure Unit and University Clinic of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
Université Paris Cité, MASCOT Inserm, Hôpitaux Universitaires Saint Louis Lariboisière, APHP, Paris, France
Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Dokuz Eylul University, Izmir, Turkey
Department of Cardiology, Rigshospitalet and Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
Armed Forces Hospital, Faculty of Medicine of Porto, Porto, Portugal
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
Emergency Medicine, University of Helsinki and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
Heart Failure Unit, Cardiology Department, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Department of Emergency Medicine, Vanderbilt University Medical Center and Veterans Affairs Tennessee Valley Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, United States
Faculty of Medicine, Kasr Al Ainy, Cardiology Department, Cairo University, Cairo, Egypt
Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius; Centre of Innovative Medicine, Vilnius, Lithuania
Onassis Cardiac Surgery Center, Athens, Greece
Karolinska Institute, Department of Medicine, and Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
Magalini Hospital, Verona, Italy
Research Direction, Consorci Sanitari Integral, Barcelona, Spain
University of Barcelona, Barcelona, Spain
Division of Cardiology, Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Scientific and Research Institute of Cardiology and Internal Disease, Almaty, Kazakhstan
Department of Cardiology and Medical Intensive Care, Augustinerinnen Hospital, Cologne, Germany
Faculty of Medicine, University of Freiburg, Freiburg, Germany
Department of Cardiology, Policlinico di Monza, Monza, Italy
Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
Institute of Heart Diseases, University Hospital, Wroclaw, Poland
Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
University of Groningen, Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
Medical Faculty, Sigmund Freud University, Vienna, Austria
3rd Medical Department, Wilhelminen Hospital, Vienna, Austria
Department of Cardiology of the University Clinical Center of Serbia, Belgrade, Serbia
Faculty of Medicine, University of Belgrade, Belgrade, Serbia
School of Nursing & Midwifery, Queens University, Belfast, United Kingdom
Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
UHasselt, Biomedical Research Institute, Faculty of Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
Vita Salute-San Raffaele University, Milan, Italy
IRCCS San Raffaele Scientific, Institute, Milan, Italy
Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Department of Cardiology (CVK) of German Heart Center Charité, Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
Royal Brompton Hospital & Harefield NHS Foundation Trust, London, United Kingdom
Heart Failure Unit, Department of Cardiology, Athens University Hospital, Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
Department of Cardiology, Center for Translational and Experimental Cardiology (CTEC), University Hospital Zurich, Zurich, Switzerland
Serbian Academy of Sciences and Arts, Belgrade, Serbia
Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
University Paris Cite, INSERM LVTS U 1148 Bichat, Paris, France
Department of Cardiology, Kings College Hospital London, London, United Kingdom
School of Cardiovascular Medicine and Sciences, Kings College London British Heart Foundation Centre of Excellence, London, United Kingdom
Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
Heart Research Institute, Sydney, Australia
Department of Medical Sciences, IRCCS San Raffaele - Roma, Roma, Italy

Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’
University of Medicine Carol Davila
Cardiology
Cardiology Department
Heart Failure Unit and University Clinic of Emergency Medicine
Université Paris Cité
Division of Cardiology
Department of Cardiology
Armed Forces Hospital
Department of Cardiology and Angiology
Emergency Medicine
Heart Failure Unit
Department of Emergency Medicine
Faculty of Medicine
Clinic of Cardiac and Vascular Diseases
Onassis Cardiac Surgery Center
Karolinska Institute
Magalini Hospital
Research Direction
University of Barcelona
Division of Cardiology
Department of Cardiology
Scientific and Research Institute of Cardiology and Internal Disease
Department of Cardiology and Medical Intensive Care
Faculty of Medicine
Department of Cardiology
Institute of Heart Diseases
Institute of Heart Diseases
Cardiology Department
University of Groningen
Emergency Department
Medical Faculty
3rd Medical Department
Department of Cardiology of the University Clinical Center of Serbia
Faculty of Medicine
School of Nursing & Midwifery
Department of Cardiology
UHasselt
Vita Salute-San Raffaele University
IRCCS San Raffaele Scientific
Cardiovascular Center Aalst
Department of Advanced Biomedical Sciences
Institut del Cor
Department of Medicine
Department of Cardiology (CVK) of German Heart Center Charité
Royal Brompton Hospital & Harefield NHS Foundation Trust
Heart Failure Unit
Department of Cardiology
Department of Cardiology
Serbian Academy of Sciences and Arts
Department of Cardiology
University Paris Cite
Department of Cardiology
School of Cardiovascular Medicine and Sciences
Department of Clinical and Molecular Medicine
Heart Research Institute
Department of Medical Sciences

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