The definition of valvular and non-valvular atrial fibrillation: results of a physicians' survey
The definition of valvular and non-valvular atrial fibrillation: results of a physicians' survey
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DOI：
10.1093/europace/euu178
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发表时间：
2014-12-01
期刊：
影响因子：
6.1
通讯作者：
Cimminiello, Claudio
中科院分区：
文献类型：
--
作者：
Molteni, Mauro;Friz, Hernan Polo;Cimminiello, Claudio
目的 评估通常治疗瓣膜性/非瓣膜性房颤 (AF) 的医生在临床实践中使用的定义的不同方面。 方法和结果 我们前瞻性地进行了一项基于网络的调查，包括参加心血管医学继续医学教育课程的心脏病专家和内科医生。我们制定了一份调查问卷，包含 17 个问题，分为五个主题：(A) 已知的风湿病病因； (B) 瓣膜受累部位/类型； (C) 人工心脏瓣膜； (D) 血流动力学相关性； （五）杂项。总体反应率为 22.4%（心脏病专家为 21.1%，内科医生为 24%）。一半的受访者认为风湿性疾病病史和瓣膜受累临床体征同时存在是诊断风湿性房颤的必要先决条件，三分之一的受访者认为单发主动脉瓣疾病足以将房颤定义为瓣膜性房颤。类似比例的受访者认为，在存在二尖瓣反流的情况下，房颤必须被定义为瓣膜病。大多数做出回应的医生认为瓣膜缺损的程度对于 AF 的瓣膜性或非瓣膜性起源的定义不太重要。 结论 我们发现通常治疗 AF 患者的医生给出的答案存在重要的异质性和不确定性，作为对 AF 起源（瓣膜性/非瓣膜性）缺乏精确和独特的定义的证据。迫切需要发布广泛接受的 AF 起源的明确定义，这将改善临床实践和研究。
Aims To assess different aspects of the definition of valvular/non-valvular atrial fibrillation (AF) used in clinical practice by physicians who usually treat this condition.Methods and results We prospectively conducted a web-based survey including cardiologists and internists who attended continuing medical education courses on cardiovascular medicine. A questionnaire was drawn up, containing 17 questions clustered into five main topics: (A) known rheumatic aetiology; (B) site/type of valve involvement; (C) prosthetic heart valve; (D) haemodynamic relevance; (E) miscellaneous. The overall response rate was 22.4%(21.1% for cardiologists and 24% for internists). Coexistence of both medical history of rheumatic disease and clinical signs of valvular involvement were considered as essential prerequisites for the diagnosis of rheumatic AF by half of the respondents, and one-third assumed that lone aortic valve disease was sufficient for AF to be defined as valvular. A similar proportion of respondents considered that in the presence of mitral regurgitation, AF had to be defined as valvular. The majority of responding physicians considered the degree of valvular defect of lesser importance for the definition of valvular or non-valvular origin of AF.Conclusion We found important heterogeneity and uncertainties in the answers given by physicians who usually treat patients with AF, as evidence of the lack of precise and unique definitions of the origin of AF (valvular/non-valvular). It is urgent to issue clear widely accepted definitions of the origin of AF, which should improve clinical practice and research.