Rational and design of EACVI-MMVD study: an international registry on multimodality imaging for mixed and multiple valvular heart disease

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Abstract Background Despite the high frequency of multiple (combination of stenotic or regurgitant lesions occurring on ≥2 cardiac valves) and mixed (combination of stenotic and regurgitant lesions on the same valve) valvular heart disease (MMVD) in clinical practice, comprehensive insights into its clinical presentation, management strategies, impact of multimodality imaging, and outcomes are not well established. Objective The "EACVI-MMVD Study" will be the first prospective international study assessing all consecutive patients with MMVD to assess its proportion, and describe baseline epidemiological, cardiovascular imaging, management, and prognosis data. Methods International prospective, multicentre, observational study led by the Heart Imagers of Tomorrow (HIT) of the European Association of Cardiovascular Imaging (EACVI) to include all consecutive patients with at least 2 moderate-to-severe VHD involving ≥2 different valves, according to the current ESC guidelines, and/or mixed VHD, defined as at least moderate stenosis and at least moderate regurgitation of a single valve, according to the current ESC guidelines. The recruitment is ongoing over 6 months, involving more than 100 centres across 30 countries. Inclusion and exclusion criteria are provided in Table 1. Results The primary outcome will be the proportion of MMVD cases assessed in echocardiographic labs over 6 months. We will then describe the clinical presentation, management strategies, cardiovascular imaging data, and 1-year prognosis of these MMVD patients (Figure 1). Physicians will determine baseline evaluation, which may include the full spectrum of multimodality imaging, such as transthoracic and transoesophageal echocardiography, stress echocardiography, computed tomography, and cardiovascular magnetic resonance. Optionally, three dedicated core laboratories will analyse cardiovascular imaging data from participating centres. Conclusion The EACVI-MMVD study will be the first and largest international multicentre study evaluating the prevalence of MMVD in clinical practice and determining the impact of multimodality imaging in MMVD patients. Table1 Inclusion and exclusion criteria Figure 1 Overview of the study