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Calcific degeneration of the aortic valve in old age: is the development of flow obstruction predictable?
A M Iivanainen1, M Lindroos, R Tilvis
1Department of Medicine, Helsinki University Central Hospital, Finland.
Insights
Aortic valve area significantly decreases over three years in the elderly population. This decline in aortic valve function is not predictable by clinical or biochemical factors, suggesting a need for longer follow-up to identify risk factors for aortic valve stenosis.
Area of Science:
- Cardiology
- Geriatrics
- Echocardiography
Background:
- Aortic valve calcification and stenosis are common in aging populations.
- Understanding age-related changes in aortic valve function is crucial for geriatric cardiovascular health.
Purpose of the Study:
- To determine if aortic valve area reduction is detectable in an unselected elderly population over time.
- To investigate if clinical or biochemical factors predict the rate of aortic valve area reduction.
Main Methods:
- A population-based prospective study involving Doppler echocardiography.
- Follow-up echocardiography was performed on 333 survivors from an initial cohort of 501 individuals.
- Measurements included aortic valve area and velocity ratio over a three-year period.
Main Results:
- A significant decrease in mean aortic valve area (1.95 cm² to 1.78 cm²) and velocity ratio (0.75 to 0.68) was observed over three years (P < 0.001).
- Changes in aortic valve area were not associated with age, sex, hypertension, coronary artery disease, diabetes, or biochemical markers.
- A weak positive association was found between decreased aortic valve area and body mass index (r = 0.16, P < 0.01).
Conclusions:
- A time-dependent reduction in aortic valve area is demonstrable in the general elderly population.
- The deterioration of aortic valve function over three years is not predictable by current clinical or biochemical characteristics.
- Longer follow-up studies are needed to identify risk factors for age-related aortic valve stenosis.
Objective:
Aortic valve calcification and stenosis become increasingly common with advancing age. This work aimed at assessing whether a time-dependent reduction of aortic valve area is detectable in an unselected elderly population and whether the rate of reduction can be predicted from clinical or biochemical characteristics.
Design:
A population-based prospective echocardiographic follow-up study.
Setting:
A university hospital.
Subjects:
In 1990, randomly selected persons born in 1904, 1909 and 1914 (total n = 501) underwent a Doppler echocardiographic study of aortic valve and biochemical tests of glucose, lipid and calcium metabolism. In 1993, echocardiography was repeated in 333 survivors of the original cohorts. These individuals constitute the present study population.
Main Outcome Measures:
Three-year changes in the aortic valve area and velocity ratio (peak outflow tract velocity/peak aortic jet velocity) determined by Doppler echocardiography.
Results:
Aortic valve area decreased from a mean of 1.95 cm2 (95% confidence interval of mean, 1.88-2.03 cm2) to 1.78 cm2 (1.71-1.85 cm2) within 3 years (P < 0.001). Concomitantly, the velocity ratio decreased from 0.75 (0.73-0.77) to 0.68 (0.67-0.70) (P < 0.001). The changes in aortic valve area and velocity ratio were unrelated to age, sex, presence of hypertension, coronary artery disease or diabetes, and to all assessed biochemical characteristics. A weak positive statistical association was found between the decrease in aortic valve area and the body mass index at entry (r = 0.16, P < 0.01).
Conclusions:
A time-dependent reduction of the aortic valve flow orifice can be demonstrated in persons representing the general elderly population. The deterioration of aortic valve function within a span of 3 years is neither clinically nor biochemically predictable. A longer follow-up may be necessary to identify the risk factors of aortic valve stenosis in old age.