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Severe aortic stenosis in elderly patients.

E Nylander, I Ekman, T Marklund

    British Heart Journal
    |May 1, 1986
    PubMed
    Summary
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    In elderly patients with suspected severe aortic stenosis, clinical and non-invasive findings often align with catheterization data. However, the absence of a single sign or symptom does not rule out severe aortic stenosis.

    Area of Science:

    • Cardiology
    • Geriatric Medicine
    • Diagnostic Imaging

    Background:

    • Severe aortic stenosis is a significant condition in elderly patients requiring accurate diagnosis.
    • Non-invasive methods are crucial for evaluating suspected aortic stenosis, but their correlation with invasive measures needs clarification.

    Purpose of the Study:

    • To compare clinical and non-invasive findings with cardiac catheterization data in elderly patients with suspected severe aortic stenosis.
    • To assess the diagnostic accuracy of various non-invasive tests in this population.

    Main Methods:

    • Retrospective analysis of 91 elderly patients (mean age 65) undergoing cardiac catheterization for suspected severe aortic stenosis.
    • Comparison of clinical symptoms (chest pain, dyspnea, syncope), electrocardiogram (ECG), chest X-ray, cineradiography, echocardiography, and exercise testing with catheterization-derived valve area and other hemodynamic data.

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  • Coronary angiography was performed in 77 patients.

    • Main Results:

    • Catheterization revealed severe aortic stenosis (valve area ≤ 0.6 cm²) in 49 patients. Aortic regurgitation was common (85%), but severe in only 1%.
    • Prevalent symptoms included chest pain (77%) and dyspnea (74%). Significant ECG abnormalities (increased QRS amplitude) were seen in 84%.
    • Echocardiography showed increased left ventricular wall thickness in 90%. Exercise tests were abnormal in 82% and discordant with NYHA classification in 25%.

    Conclusions:

    • Clinical and non-invasive findings in elderly patients with suspected severe aortic stenosis largely mirror those in younger populations.
    • The presence of multiple indicators strongly suggests severe aortic stenosis, but the absence of any single finding does not exclude the diagnosis.
    • Comprehensive evaluation integrating various non-invasive modalities is essential for accurate diagnosis and management planning.