Research Article | Volume 20 Issue 1 (Jan-Dec, 2015) | Pages 1 - 4
Update on the ESC Eurobservational Research Programme Registries
1
Authors affiliations: Unit of Cardiology, Department of Medicine, Karolinska Institute and Heart & Vascular Theme, Karolinska University Hospital Solna, Stockholm, Sweden Address for correspondence: Francesco Cosentino, MD, PhD, FESC, Unit of Cardiology, Department of Medicine, Karolinska Institute & Karolinska University Hospital Solna, S1:02 Stockholm, Sweden
Under a Creative Commons license
Open Access
Received
Jan. 1, 2017
Revised
May 5, 2017
Accepted
July 8, 2017
Published
Dec. 31, 2017
Abstract

The 2017 ESC congress, one entire session titled “Valuable lessons on frequent diseases – insights from ESC registries” was dedicated to the EURObservational Research Programme (EORP).1 Alec Vahanian (FR), the EORP Oversight Committee chairman, presented the EORP, which was started in 2009 by the ESC to obtain epidemiological, diagnostic, and therapeutic data to improve the understanding of cardiovascular diseases and facilitate adherence to the guidelines. There are 20 registries that constitute EORP,
which are categorized as general registries (Heart Failure, Atrial Fibrillation General, Chronic Ischemic Cardiovascular Disease, Acute Coronary Syndrome STEMI), sentinel registries (Atrial Fibrillation Ablation, TransCatheter Valve Treatment, European Lead Extraction ConTRolled, Epicardial/Hybrid Atrial Fibrillation Ablation Registry, Valvular Heart Disease II), special registries (Registry Of Pregnancy And Cardiac Disease, PeriPartum CardioMyopathy, Cardiomyopathy and Myocarditis, Cardiac Oncology Toxicity, European Infective Endocarditis Registry), and prevention registries (EuroAspire IV and EuroAspire V). Currently, 100,000 patients from more than
2 200 centers have been enrolled in the EORP registries.1,2

VALVULAR HEART DISEASE II REGISTRY

Bernand Lung (FR) presented the objectives and design of the Valvular Heart Disease II registry, as well as some preliminary data. The main aims of the registry are to analyze the current clinical practice for the management of patients with valvular heart disease, to evaluate adherence to the ESC guidelines in this setting, and to assess the changes in practice following the previous survey in 2001 and in the 6-month outcomes (mortality and morbidity) after study enrollment according to the management strategy. Until August 2017, 7 090 patients (47% female; median. age, 71 years) were enrolled; 62% were inpatients and the most common reason for hospital referral/consultation was a diagnostic evaluation (33%). Native left-sided and native isolated right-sided valvular heart disease was reported in 71% and 3% of the patients, respectively, with 26% who had previously undergone a valve intervention. The most frequently reported left-sided valvular heart disease was aortic stenosis (54%), followed by mitral regurgitation (31%). For patients with left-sided valvular heart disease, 73% were single-valve diseases. Among patients with a previous valve intervention (28%), 82% had a valve replacement and 18% a valve repair. Inpatients were more likely to have undergone a valve intervention (41%) or to have an intervention scheduled (24%) vs outpatients (7% and 21%, respectively). These data represent a detailed overview of valvular heart disease in Europe; however, more data on the clinical characteristics of patients with valvular heart disease and additional data on the concordance with the guidelines and on the outcomes are expected to be available soon.

CHRONIC ISCHEMIC CARDIOVASCULAR DISEASE REGISTRY

Michael Komajda (FR) presented the 6-month follow-up data from the chronic ischemic cardiovascular disease registry. The 2 420 patients (31% female; median age, 67 years) who were included in the registry were divided into 4 cohorts: (i) patients with chronic CAD and NSTE-ACS who were revascularized within 72 hours after symptom onset (ACS PCI group); (ii) patients with chronic stable CAD who had undergone an elective PCI (elective PCI group); (iii) patients with stable CAD who were not revascularized (stable CAD group); and (iv) patients with peripheral artery disease who were revascularized (PAD group). At 6 months, 23.7% of the population reported all-cause death or hospitalization, and 1514 of the 1579 clinical events (death/hospitalization) were cardiovascular events. The composite of all-cause and cardiovascular death/hospitalization were more frequently reported in the ACS PCI group and the PAD group vs the elective PCI group. No differences were observed in the outcomes between the stable CAD group and the elective PCI group.  

 

Predictors of any death/hospitalization included higher age, having CAD and NSTE-ACS with an urgent revascularization, living in Eastern vs Southern coun- tries, a higher heart rate, previous peripheral revascularization, chronic kidney disease, and chronic obstructive pulmonary disease (univariate analysis). All of these factors, with the exception of chronic kidney disease, were also associated with the risk of cardiovascular death/hospitalization risk. The Chronic Ischemic Cardiovascular Disease registry is expected to provide data on the comparison between real-world clinical practice and guideline-recommended management of patients with chronic ischemic cardiovascular disease and to assess both the geo- graphical differences in outcomes and the long-term prognosis for these patients.

CARDIOMYOPATHY AND MYOCARDITIS REGISTRY

Philippe Charron (FR) discussed data from the Cardiomyopathy and Myocarditis registry. In the long-term phase of the program, 3 109 patients from 23 countries were enrolled, of whom 75% had adult cardiomyopathy, 13% had pediatric cardiomyopathy, and 12% had myocarditis. In particular, among those with adult cardiomyopathy, 51% had hypertrophic cardiomyopathy (HCM), 43% dilated cardiomyopathy (DCM), 4% arrhythmogenic right ventricular cardiomyopathy (ARVC), and 2% restrictive cardiomyopathy (RCM). 

 

Data from the long-term phase of the program have been pooled with those from the previous pilot phase to provide a better comparison of the characteristics of patients with different cardiomyopathies., In particular, familial involvement was more frequent in patients with HCM (48.5%), followed by patients with ARVC (40.6%), RCM (30%), and DCM (25.2%). More patients with RCM had a history of atrial fibrillation (48.5%), followed by patients with DCM (28.3%), HCM (26.6%), and ARVC (14%); whereas, more patients with ARVC had a history of sustained ventricular tachycardia (39.2%), followed by patients with DCM (13.6%), HCM (7.7%), and RCM (1.5%). The diagnosis was performed earlier in ARVC (mean age, 40.2±15.5 years) and later in RCM (52.4±19.6). 

 

Regarding diagnostic tests, magnetic resonance imaging was performed in 51%, 36.4% 33.8%, and 20.6% of patients with ARVC, RCM, HCM, and DCM, respectively, and genetic testing was performed in 54.6%, 46.4%, 42.9%, and 17.9% of patients with ARVC, HCM, RCV and DCM, respectively. An implantable cardioverter-defibril- lator was implanted in 56.6%, 31.7%, 19.9%, and 9.1% of patients with ARVC, DCM, HCM, and RCM, respectively. Cardiac ablation was performed mainly in patients with ARVC (11.2%). There were geographical differences observed for several clinical characteristics, diagnostic tests, and treatments used. The data from this. registry provide a contemporary overview of cardiomyopathies and a useful platform for guideline implementation. In 2018, data on pediatric cardiomyopathies and myocarditis are expected to be released. 

CONCLUSION

As reported by Aldo Maggioni (IT), the EORP scientific coordinator, the EORP activities are a rich source of knowledge for cardiovascular diseases. Thus, the EORP registries represent an incredible tool to understand the unmet needs in cardiovascular
disease, which may contribute significantly to improving daily clinical practice.

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