Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample

First Department of Medicine, Helsinki University Central Hospital, Finland.

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.

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				Y. Agmon, B. K. Khandheria, I. Meissner, J. D. Sicks, W. M. O'Fallon, D. O. Wiebers, J. P. Whisnant, J. B. Seward, and A. J. Tajik Aortic valve sclerosis and aortic atherosclerosis: different manifestations of the same disease?: Insights from a population-based study J. Am. Coll. Cardiol., September 1, 2001; 38(3): 827 - 834. [Abstract] [Full Text] [PDF]

				C. M OTTO and K. D O'BRIEN Why is there discordance between calcific aortic stenosis and coronary artery disease? Heart, June 1, 2001; 85(6): 601 - 602. [Full Text]

				B J Bouma, J H P van der Meulen, R B A van den Brink, A E R Arnold, A Smidts, L H Teunter, K I Lie, and J G P Tijssen Variability in treatment advice for elderly patients with aortic stenosis: a nationwide survey in the Netherlands Heart, February 1, 2001; 85(2): 196 - 201. [Abstract] [Full Text]

				P. Das, C. Pocock, and J. Chambers The patient with a systolic murmur: severe aortic stenosis may be missed during cardiovascular examination QJM, October 1, 2000; 93(10): 685 - 688. [Abstract] [Full Text] [PDF]

				T. E. Strandberg and R. S. Tilvis C-Reactive Protein, Cardiovascular Risk Factors, and Mortality in a Prospective Study in the Elderly Arterioscler Thromb Vasc Biol, April 1, 2000; 20(4): 1057 - 1060. [Abstract] [Full Text] [PDF]

				G. M. LONDON, B. PANNIER, S. J. MARCHAIS, and A. P. GUERIN Calcification of the Aortic Valve in the Dialyzed Patient J. Am. Soc. Nephrol., April 1, 2000; 11(4): 778 - 783. [Full Text] [PDF]

				P. Kvidal, R. Bergstrom, L.-G. Horte, and E. Stahle Observed and relative survival after aortic valve replacement J. Am. Coll. Cardiol., March 1, 2000; 35(3): 747 - 756. [Abstract] [Full Text] [PDF]

				U. Bortolotti, G. Scioti, A. Milano, M. De Carlo, R. Codecasa, C. Nardi, and G. Tartarini Performance of 21-mm size perimount aortic bioprosthesis in the elderly Ann. Thorac. Surg., January 1, 2000; 69(1): 47 - 50. [Abstract] [Full Text] [PDF]

				T Gilbert, W Orr, and A P Banning Surgery for aortic stenosis in severely symptomatic patients older than 80 years: experience in a single UK centre Heart, August 1, 1999; 82(2): 138 - 142. [Abstract] [Full Text] [PDF]