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The echo Doppler spectrum of valvular abnormalities in the hospitalized octogenarian
J P Zavitsanos1, A P Goldman, M N Kotler
1Department of Medicine, Albert Einstein Medical Center, Temple University School of Medicine, Philadelphia, Pennsylvania 19141.
Insights
Valvular abnormalities like regurgitation and stenosis are common in octogenarians. Doppler echocardiography revealed significant cardiac valve issues in a substantial portion of elderly patients studied.
Area of Science:
- Cardiology
- Geriatric Medicine
- Diagnostic Imaging
Background:
- Cardiac valves undergo age-related changes, including thickening and opacity.
- With increased longevity and evolving treatments like valvuloplasty, understanding valvular abnormalities in the elderly is crucial.
Purpose of the Study:
- To define the prevalence and significance of cardiac valvular abnormalities in octogenarians.
- To assess findings detected by Doppler echocardiography in this population.
Main Methods:
- Retrospective study of 628 octogenarian patients (547 analyzed).
- Doppler echocardiography used to detect and quantify valvular regurgitation and stenosis.
- Significant regurgitation defined as jet >2 cm; significant aortic stenosis as gradient >50 mmHg.
Main Results:
- Mitral regurgitation (MR) in 60.5% (15% significant), aortic regurgitation (AR) in 50.5% (12.8% significant), tricuspid regurgitation (TR) in 23.9% (5.5% significant).
- Aortic stenosis (AS) detected in 29.3%, with 12.8% significant (gradient >50 mmHg).
- Significant AS was an unexpected finding in 40% of affected patients.
Conclusions:
- Valvular pathology is highly prevalent in the octogenarian population.
- Doppler echocardiography is effective in identifying significant valvular abnormalities in the elderly.
- Findings highlight the importance of cardiac valve assessment in geriatric patients.
Abstract:
Cardiac valves thicken and become more opaque with advancing age. As more individuals live longer and as more treatment modalities such as valvuloplasty evolve, the presence and significance of these valvular abnormalities become important. We retrospectively studied 628 octogenarian patients to try and define further the presence and significance of these abnormalities detected by Doppler echocardiography. A group of 547 patients were suitable for analysis. Age ranged from 80 to 96 years (mean 84.4). The female:male ratio was 1.9:1. Mitral, aortic, and tricuspid regurgitation (MR, AR, and TR) were significant if the jet moved greater than 2 cm from the plane of the valve away or toward the transducer, depending on transducer position. Mitral regurgitation was detected in 331 patients (60.5%) and was significant in 82 patients (15%). Aortic regurgitation was detected in 276 patients (50.5%) and was significant in 70 patients (12.8%). Tricuspid regurgitation was detected in 131 patients (23.9%) and was significant in 30 patients (5.5%). Regurgitant lesions were detected in two valves in 150 patients (27.4%) three valves in 57 patients (10.4%), in all four valves in 17 patients (3.1%). Aortic stenosis was detected in 160 patients (29.3%). The gradient range was 16-156 mmHg (mean 47.8). Significant aortic stenosis was present in 70 patients (12.8%) (gradient greater than 50 mmHg), of whom 54 had isolated pure aortic stenosis and 16 had mixed lesion. In 40% of these patients, significant aortic stenosis was an unexpected finding at two-dimensional echocardiography. Valvular pathology is common in the octogenarian population.(ABSTRACT TRUNCATED AT 250 WORDS)