Large-scale assessment of aortic stenosis: facing the next cardiac epidemic?

Ramos, J M Guerra; Monteagudo, J M; González‐Alujas, Teresa; Fuentes, María Eugenia; Sitges, Marta; Peña, María Luisa Peña; Carrasco-Chinchilla, Fernando; Echeverría, Tomás; Bouzas, Alberto; Albertí, José Francisco Forteza; Mesa, Dolores; Hera, Jesús M. de la; Zamorano, José Luís

doi:10.1093/ehjci/jex223

Cited by 25 publications

(15 citation statements)

References 31 publications

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“… 17 Similar findings were achieved in a systematic large-scale screening in ~30 000 patients with conventional 2D echocardiography on referral to hospital (7.2%). 18 Although both studies showed a higher AS prevalence than our study, they used full-time sonographers using fully equipped echocardiography machines, while our study used full-time primary care physicians using target 2D scanning alone. Whole population screening using formal echocardiography in those aged >65 years is unlikely as, although the test is relatively cheap, there is a shortage of the required highly skilled accredited sonographers in the UK.…”

Section: Discussioncontrasting

confidence: 52%

Community-based aortic stenosis detection: clinical and echocardiographic screening during influenza vaccination

Steeds

Potter²,

Mangat³

et al. 2021

Open Heart

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BackgroundDegenerative aortic stenosis (AS), the most common valvular heart disease in the Western world, is often diagnosed late when the mortality risk becomes substantial. We determined the feasibility of AS screening during influenza vaccination at general practitioner (GP) surgeries in the UK.MethodsConsecutive subjects aged >65 years presenting to a GP for influenza vaccination underwent heart auscultation and 2D echocardiography (V-scan). Based on these findings, a patient management strategy was determined (referral to cardiologist, review within own practice or no follow-up measures) and status at 3 months was determined.Results167 patients were enrolled with a mean age of 75 years. On auscultation, a heart murmur was detected in 30 of 167 (18%) patients (6 subjects with an AS-specific and 24 with a non-specific murmur). 75.2% of those with no murmur had a negative V-scan finding. Conversely, 16 of 30 (53%) patients with any murmur had an abnormal V-scan finding that was largely related to the aortic valve. Using clinical auscultation and V-scan screening, a decision not to pursue follow-up measures was taken in 147 (88%) cases, whereas 18 (10.8%) subjects were referred onward; with 5 of 18 (27.8%) and 3 of 18 (16.7%) being diagnosed with mild and moderate AS.ConclusionsOur pilot study confirms feasibility of valvular heart disease screening in the elderly in a primary care setting. Using simple and inexpensive diagnostic measures and 7.3 million UK inhabitants undergoing influenza vaccination, nationwide screening could potentially identify 130 000 patients with moderate AS and a significant number of patients with severe AS.

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Section: Discussioncontrasting

confidence: 52%

Community-based aortic stenosis detection: clinical and echocardiographic screening during influenza vaccination

Steeds

Potter²,

Mangat³

et al. 2021

Open Heart

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“…The incidence of degenerative aortic stenosis (DAS) increases with age, and the coincidence of elderly age, severe DAS, cardiovascular comorbidities, e.g. hypertension, atherosclerosis, arrhythmias, diabetes is commonplace [1][2][3][4]. DAS, is not only a valvular disease, but stenosis leads to extra valvular cardiac complications such as left ventricular hypertrophy, remodeling, fibrosis and myocardial dysfunction [5].…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Willis circle flow changes and the severity of degenerative aortic stenosis and cognitive impairment

Baran¹,

Przewłocki²,

Podolec³

et al. 2021

Kardiol Pol

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“…[2][3][4] For years, it has been suggested that classical cardiovascular risk factors such as diabetes, hyperlipidemia, arterial hypertension, smoking, and familial predisposition promote the pathogenesis of calcific aortic valve stenosis. 5,6 In addition to a disturbed calcium metabolism and immunological influences, 7 in particular subacute or acute endocarditis is responsible for the development of sVHD. 8 In 2004 Cohen and colleagues 9 confirmed a link between subclinical bacterial endocarditis and calcification of the aortic valve in an animal model.…”

Section: Perspectivementioning

confidence: 99%