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Valvular heart disease: a call for global collaborative research initiatives
  1. John B Chambers1,
  2. Benoy N Shah2,
  3. Bernard Prendergast3,
  4. Patricia V Lawford4,
  5. Gerry P McCann5,
  6. David E Newby6,
  7. Simon Ray7,
  8. Norman Briffa8,
  9. David Shanson9,
  10. Guy Lloyd10,
  11. Roger Hall11,
  12. on behalf of the British Heart Valve Society
  1. 1Department of Cardiology, St. Thomas’ Hospital, London, UK
  2. 2National Heart & Lung Institute, Imperial College, London, UK
  3. 3Department of Cardiology, John Radcliffe Hospital, Oxford, UK
  4. 4Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
  5. 5Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester, Glenfield General Hospital, Leicester, UK
  6. 6Centre for Cardiovascular Sciences, Royal Infirmary, Edinburgh, UK
  7. 7Department of Cardiology, University Hospital of South Manchester, Manchester, UK
  8. 8Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK
  9. 9Department of Medical Microbiology, Great Ormond Street Hospital, London, UK
  10. 10Department of Cardiology, Eastbourne General Hospital, Eastbourne, UK
  11. 11Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
  1. Correspondence to Professor John B Chambers, Department of Cardiology, Cardiothoracic Centre, St Thomas’ Hospital, London SE1 7EH, UK; john.chambers{at}gstt.nhs.uk

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Introduction

The burden of valvular heart disease (VHD) is rising rapidly as life expectancy increases. The prevalence in the USA alone is 13% in those aged over 75 years,1 while the global prevalence of rheumatic heart disease is estimated at 15.6–19.6 million.2 Despite this, the treatment of VHD still lacks an adequate research base. None of the 64 recommendations in the 2012 European Society of Cardiology (ESC) VHD guidelines3 had Level A evidence and only 14% had Level B evidence. This compares with 28% at Level A and 42% at Level B among the 270 recommendations in the 2010 ESC myocardial revascularisation guidelines.4 Therefore, there is an urgent need to stimulate the investigation. In this article, we identify deficits in our knowledge which may be amenable to research and make a call for national and international collaborative efforts to address this evidence gap.

Epidemiology/natural history

The prevalence of VHD in industrialised countries has been extrapolated from studies predominantly conducted in the USA,1 while the prevalence of rheumatic disease in sub-Saharan Africa is extrapolated from studies in North Africa. True figures need to be established nationally, while for rare causes of VHD (eg, carcinoid or antiphospholipid syndrome), this might be better done using international registries with standardised protocols. Serial echocardiography within these projects will improve our understanding of the contemporary natural history of VHD, which was previously determined in small cohorts of patients and generally with fewer comorbidities compared with the present.

Basic biology/physiology

The genetics and developmental biology of VHD are poorly understood. Collation of genetic analyses from established bio-banks and twin studies may identify new determinants of disease or its progression. Such techniques may also provide clues towards the development of treatments for challenging conditions such as endomyocardial fibrosis. Lipid-lowering therapy has not been successful in modifying the progression …

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