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Degenerative calcific valvular disease and systolic murmurs in the elderly
Insights
Degenerative calcific valvular disease (DCVD) is common in elderly men, affecting 74%. Most cases are not functionally significant, but echocardiography can identify those needing further study.
Area of Science:
- Cardiology
- Geriatrics
- Diagnostic Imaging
Background:
- Degenerative calcific valvular disease (DCVD) is a common finding in the elderly.
- Systolic murmurs are frequently detected in older individuals, but their etiology is not always clear.
Purpose of the Study:
- To define the prevalence, morphology, functional significance, and association with systolic murmurs of DCVD in elderly men.
- To establish echocardiographic criteria for identifying significant valvular dysfunction.
Main Methods:
- Prospective study of 98 elderly men (ages 65-102) using echocardiographic and radiologic imaging.
- Assessment of valvular morphology, presence of murmurs, and functional significance.
Main Results:
- DCVD diagnosed in 74% of subjects, with prevalence increasing with age.
- Systolic murmurs detected in 55%, often associated with aortic and/or mitral valve degeneration.
- Only 7% of DCVD cases were functionally significant (moderate or less).
Conclusions:
- DCVD is the primary cause of most systolic murmurs in the elderly.
- The majority of DCVD cases are hemodynamically unimportant.
- Echocardiography is crucial for identifying elderly patients with potentially significant valvular dysfunction requiring further investigation.
Abstract:
By use of echocardiographic and radiologic imaging, a prospective study was made of 98 elderly men, 65 to 102 years old, to define degenerative calcific valvular disease (DCVD)--its prevalence, morphologic features, functional significance, and relationship to systolic murmurs in the elderly. DCVD was diagnosed in 74 per cent of the group and murmurs were detected in 55 per cent, the incidences increasing with age. Fibrotic and calcific change of the aortic valve was the most common abnormality, occurring alone or together with alteration of the mitral valve. The murmurs were characteristically early systolic, of low intensity and medium pitch, and heard at more than one area. Of the group with valve degeneration, only 7 per cent was judged to be functionally significant and no more than moderate. It was concluded that DCVD is the cause of most systolic murmurs in the elderly and is usually hemodynamically unimportant. Echocardiographic criteria are important in identifying those subjects with possibly significant valvular dysfunction requiring invasive study.