Aortic Stenosis Commonly Found With Routine Echocardiography

By Lisa Rapaport

September 27, 2021

(Reuters Health) - Routine echocardiography often identifies incident aortic stenosis among both men and women being monitored for heart disease, a new study suggests.

Researchers examined data on 49,449 male (mean age 60.9 years) and 42,229 female (mean age 61.6 years) cardiac patients who had no aortic stenosis at baseline and received routine echocardiography multiple times during a median follow-up period of 2.8 years.

By the end of follow-up, a total of 6,293 patients (6.9%) had new evidence of aortic stenosis on their most recent echocardiogram, including 3,203 men and 3,090 women. This translated into a rate of 17.5 cases per 1,000 person-years among men and 18.7 cases per 1,000 person-years among women.

"It has been estimated that 50% of patients with valvular disease do not know they have it," said senior study author Dr. Geoff Strange, a professor in the school of medicine at the University of Notre Dame, in Fremantle, Australia.

"It's not that surprising to our group that there are so many patients identified during routine echo," Dr. Strange said by email.

Age played a role. Among men under 30, the incidence of aortic stenosis was 5.1 cases per 1,000 person-years, compared with 43 cases per 1,000 person-years among men over 80. Among women under 30, the incidence of aortic stenosis was 5.0 cases per 1,000 person-years, compared with 39 cases per 1,000 person-years among women over 80.

Among all the patients identified with aortic stenosis, a total of 5,170 cases were mild, 636 cases were moderate, 339 cases were severe low-gradient, and 148 cases were severe high gradient.

Over a longer follow-up period of 7.7 years, a total of 24,577 (26.8%) people in the study died from all causes. Mortality rates rose with increasing severity of incident aortic stenosis, climbing from 25.8% among those without any evidence of the condition to 50% or higher among those with low- or high-gradient severe aortic stenosis.

Compared to those without aortic stenosis, mortality was significantly higher for those with moderate (HR 1.83) and with severe high-gradient (HR 2.65) aortic stenosis.

One limitation of the data is that the researchers lacked granular data on individual patients such as comorbidities, prescriptions, medical device utilization and hospitalizations that might influence the risk of aortic stenosis and mortality during follow-up, the authors note in Heart.

However, previous research has already documented that aortic stenosis is a common finding, particularly in older individuals, said Dr. Liam Ring of the West Suffolk Hospital NHS Foundation Trust in Bury St Edmunds, UK.

"As such, this study largely corroborates what has already been established," Dr. Ring, who wasn't involved in the study, said by email. "What is new in this study is the sheer volume of patients that were included in the analysis, which is remarkable."

SOURCE: Heart, online August 25, 2021.