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Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample
M Lindroos1, M Kupari, J Heikkilä
1First Department of Medicine, Helsinki University Central Hospital, Finland.
Insights
Calcific aortic valve stenosis is a significant health issue in the elderly, affecting 2.9% of individuals aged 75-86. Many with operable aortic valve stenosis do not receive surgery.
Area of Science:
- Cardiology
- Geriatrics
- Valvular Heart Disease
Background:
- Increasing age of patients undergoing treatment for valve disorders.
- Need for more data on aortic valve disease prevalence in older populations.
Purpose of the Study:
- To determine the prevalence of aortic valve abnormalities in the elderly population.
- To assess the incidence of aortic valve stenosis and regurgitation in older adults.
Main Methods:
- Echocardiography and Doppler imaging used on 501 elderly individuals (75-86 years) and 76 younger adults (55-71 years).
- Calculation of systolic aortic valve area and velocity ratio to diagnose aortic stenosis.
- Visual assessment of valve regurgitation and cusp calcification.
Main Results:
- Aortic valve abnormalities were assessable in 96% of participants.
- Mild calcification found in 40%, severe in 13%.
- Critical native valve stenosis identified in 2.2% of the elderly cohort, primarily in the oldest age groups. Aortic regurgitation present in 29%.
Conclusions:
- Calcific aortic valve stenosis is a notable health concern in the elderly.
- A significant number of elderly individuals with operable aortic valve stenosis do not undergo surgical intervention.
Objectives:
This study was undertaken to elucidate the prevalence of aortic valve abnormalities in the elderly.
Background:
The age of persons treated actively for valve disorders is increasing. More information is needed about the prevalence of aortic valve disease in old age.
Methods:
Randomly selected men and women in the age groups 75 to 76, 80 to 81 and 85 to 86 years (n = 501) participating in the Helsinki Ageing Study were studied with imaging and Doppler echocardiography. Additionally, 76 persons 55 to 71 years of age were included. The systolic aortic valve area was calculated by the continuity equation. The velocity ratio (peak velocity in the left ventricular outflow tract/peak velocity across the aortic valve) was a supplementary criterion for aortic stenosis. Valve regurgitation and cusp calcification were assessed visually.
Results:
Evaluation of the aortic valve was possible in 552 persons (96%). Mild calcification was found in 222 (40%) and severe calcification in 72 (13%). Two persons (0.4%) had an aortic valve prosthesis. Critical native valve stenosis (calculated aortic valve area < or = 0.8 cm2 and velocity ratio < or = 0.35) was found in 12 persons (2.2%). Six of these were symptomatic and potentially eligible for valvular surgery. All persons with aortic valve stenosis were in the three oldest age groups. The prevalence of critical aortic valve stenosis was 2.9% (95% confidence interval 1.4% to 5.1%) in the group 75 to 86 years of age. Aortic regurgitation, mostly mild, was found in 29% of the entire study cohort.
Conclusions:
Calcific aortic valve stenosis constitutes a significant health problem in the elderly. Only a minority of those with potentially operable aortic valve stenosis undergo surgery.