Aortic valve stenosis: Survey on practice in the north of France

Abstract

Aortic stenosis has become the most frequent type of valvular heart disease in Europe. Severe Aortic Stenosis (SAS) is defined as an aortic valve area b1 cm (or 0.6 cm/m), a mean transvalvular gradient N40 mmHg, a peak velocity N4 m/s, and permeability index b25% [1]. Some patients may have lower than expected transvalvular gradients (b40 mmHg) as a consequence of “low flow/low gradient SAS with depressed LVEF” or in the recently described “paradoxical low gradient aortic stenosis”. This survey was designed to explore practices on aortic valve stenosis, with particular interest for the management of patients with “nonclassical” aortic stenosis, for which guidelines were lacking in 2012. From June to November 2012, all graduated cardiologists of the region “Nord-Pas-de-Calais”were asked to answer a survey on SAS and received a questionnaire comprising 5 clinical scenarios of SAS. A choice of four different responses to each scenariowas proposed, i.e. surgical treatment, trans-aortic valve implantation, medical treatment with follow up or complementary explorations. An echocardiography specialist was defined as a cardiologist who performed more than 25 echocardiographies a week and an aortic stenosis specialist as a practitioner who diagnosed more than 40 aortic stenosis a year. Categorial variables were compared with the Chi-squared test of Pearson. A p-value≤ 0.05 was considered for statistical significance. Analysiswas conducted using Statistical Package for Social Sciences (SPSS, v17.0) software. 313 cardiologists were surveyed. The response rate was 29.7% (93/ 313) overall. Cardiologists' mean age was 42.6 ± 11.4 years old. 36 (38.7%) of them were echocardiography specialists and 30 (32.3%) were aortic stenosis specialists. 35 (37.6%) cardiologists worked in a teaching hospital, 32 (34.4%) in a general hospital, and 26 (26%) have a nonhospital activity.