Controversial test could be leading to unnecessary open heart operations

Posted by ap507 at Feb 24, 2017 11:12 AM |
University of Leicester researcher leads aortic stenosis study

Issued by University of Leicester Press Office on 24 February 2017    

An approved international test to check whether people need open heart surgery could be sending twice as many people under the knife unnecessarily, at a cost of nearly £75m, research by the University of Leicester has suggested.

Since 2012 doctors have been using exercise testing on people with a condition called aortic stenosis (AS) to determine whether they need an operation to save their life.

However, a study, led by Gerry McCann, Professor of Cardiac Imaging and Honorary Consultant Cardiologist from the University of Leicester Department of Cardiovascular Sciences, who conducted the research as part of a NIHR Fellowship, has shown the current approach is “highly inaccurate” and if followed may send thousands of patients to surgery before it is needed.

The exercise test, which involves cycling on a stationary bike, is used to determine whether surgery is needed for people with the condition – but it only has a 60 per cent accuracy rate, the study found.

AS, which is the narrowing of the aortic heart valve, affects predominantly older people and affects up to three per cent of people over 75 years of age. Symptoms, such as chest pain, breathlessness and feeling faint, can take years to develop. However, when they do it means the person is seriously ill and could die from heart failure or sudden death.

If exercise test participants become breathless, they are recommended to have valve replacement therapy. About 10,000 aortic valve replacements are performed every year at a cost of up to £15,000. Hospital recuperation then takes between seven and 10 days. 

Professor McCann, who is also a consultant cardiologist from the NIHR Leicester Cardiovascular Biomedical Research Unit (BRU), said: “There is no doubt that valve replacement therapy is highly effective for patients with symptoms, however there are risks involved. It’s a major operation and there’s a one per cent chance of people dying or having a stroke during or after. There’s also the chance they could develop an infection.

“It can often take six months to recover, but if they survive they tend to do very well afterwards. However, if we know a patient has AS and no symptoms and we do nothing there’s also a one per cent chance they will die so there’s a fine line between whether we should intervene or not.

“Our findings showed that this exercise test, which has been approved by the American Heart Association/American College of Cardiology and the European Society of Cardiology, was highly inaccurate as almost twice the number of people who became breathless during the test did not develop symptoms within a year.”

The findings have been published in the world-leading European Heart Journal1, which showcases work often considered in future guidelines. 

Professor McCann now wants to conduct further research to find a more accurate way to determine whether doctors should wait for symptoms to develop or to intervene beforehand. Ultimately a clinical study comparing early surgery versus waiting for symptoms to develop is needed.

The study was funded by the NIHR and most of the research was carried out at the NIHR Leicester Cardiovascular BRU.

The NIHR BRUs are focused on translational clinical research, taking new ideas from the laboratory bench to the patient’s bedside to improve health.

The NIHR Leicester Cardiovascular BRU at Glenfield Hospital harnesses the power of experimental science to explore and develop ways to help prevent and treat cardiovascular conditions.

The BRU is one of 20 units around England funded by the NIHR, the research arm of the NHS.

ENDS

Notes to editors:

Study info

1Comparison of exercise testing and CMR measured myocardial perfusion reserve for predicting outcome in asymptomatic aortic stenosis: the Prognostic Importance of Microvascular Dysfunction in Aortic Stenosis (PRIMID AS) Study” by A. Singh et al. European Heart Journal, doi: 10.1093/eurheartj/ehx001

The paper can be viewed here: https://academic.oup.com/eurheartj/article-lookup/doi/10.1093/eurheartj/ehx001

For further details, to arrange an interview or more photographs, email oliver.jelley@ojpr.co.uk or Fiona.bailey@ojpr.co.uk call 07803 003811 or 01604 882342.

The NIHR Leicester Cardiovascular Biomedical Research Unit at Glenfield Hospital aims to improve the diagnosis, prognosis and treatment of cardiovascular diseases. The unit provides state-of-the-art facilities and equipment to assist researchers in their complex projects. LCBRU is one of 20 BRUs in England funded by the NIHR. LCBRU is a partnership between the University of Leicester and University Hospitals of Leicester NHS Trust. The Unit's director is Professor Sir Nilesh Samani and the manager is Dr Martin Batty. www.le.ac.uk/bru

The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. The NIHR is the research arm of the NHS. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (www.nihr.ac.uk). centres of excellence and systems represent the most integrated health research system in the world. For further information, visit http://www.nihr.ac.uk.

The University of Leicester is led by discovery and innovation. Find out more: https://le.ac.uk/about-us. Follow on Twitter @uniofleicester and @UoLNewsCentre 

 

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