The evolving epidemiology of valvular aortic stenosis. The Tromsø Study
Objective To assess prevalence, incidence, prognosis and progression of degenerative valvular aortic stenosis (AS). Setting The Tromsø Study and the University Hospital of North Norway. Design Population based prospective study. Population Over a 14 year span we performed three repeated echocardiogr...
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| Published in | Heart (British Cardiac Society) Vol. 99; no. 6; pp. 396 - 400 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
England
BMJ Publishing Group Ltd and British Cardiovascular Society
01.03.2013
BMJ Publishing Group LTD |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Objective To assess prevalence, incidence, prognosis and progression of degenerative valvular aortic stenosis (AS). Setting The Tromsø Study and the University Hospital of North Norway. Design Population based prospective study. Population Over a 14 year span we performed three repeated echocardiographic examinations (1994, 2001 and 2008) of a random sample of initially 3273 participants. Data from the only hospital serving this population were included. Results There were 164 subjects with AS. Prevalence consistently increased with age, average values being 0.2% in the 50–59 year cohort, 1.3% in the 60–69 year cohort, 3.9% in the 70–79 year cohort and 9.8% in the 80–89 year cohort. The incidence rate in the study was 4.9‰/year. The mean annual increase in mean transvalvular pressure gradient was 3.2 mm Hg. The increase was lower in mild AS than in more severe disease, disclosing a non-linear development of the gradient, but with large individual variations. Mortality was not significantly increased in the asymptomatic AS-group (HR=1.28), nor in those who received aortic valve replacement (n=34, HR=0.93), compared with the general population. Conclusion This is the first study to document the incidence and prognosis of AS in a general population with surgery as a treatment option. It reveals an accelerated progression of the aortic mean gradient as the disease advances. The prognosis of AS seems to be comparable with the normal population in the asymptomatic stage and after successful surgery, indicating that the follow-up and timing of surgery has been adequate for this patient group. |
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| AbstractList | To assess prevalence, incidence, prognosis and progression of degenerative valvular aortic stenosis (AS).OBJECTIVETo assess prevalence, incidence, prognosis and progression of degenerative valvular aortic stenosis (AS).The Tromsø Study and the University Hospital of North Norway.SETTINGThe Tromsø Study and the University Hospital of North Norway.Population based prospective study.DESIGNPopulation based prospective study.Over a 14 year span we performed three repeated echocardiographic examinations (1994, 2001 and 2008) of a random sample of initially 3273 participants. Data from the only hospital serving this population were included.POPULATIONOver a 14 year span we performed three repeated echocardiographic examinations (1994, 2001 and 2008) of a random sample of initially 3273 participants. Data from the only hospital serving this population were included.There were 164 subjects with AS. Prevalence consistently increased with age, average values being 0.2% in the 50-59 year cohort, 1.3% in the 60-69 year cohort, 3.9% in the 70-79 year cohort and 9.8% in the 80-89 year cohort. The incidence rate in the study was 4.9‰/year. The mean annual increase in mean transvalvular pressure gradient was 3.2 mm Hg. The increase was lower in mild AS than in more severe disease, disclosing a non-linear development of the gradient, but with large individual variations. Mortality was not significantly increased in the asymptomatic AS-group (HR = 1.28), nor in those who received aortic valve replacement (n = 34, HR = 0.93), compared with the general population.RESULTSThere were 164 subjects with AS. Prevalence consistently increased with age, average values being 0.2% in the 50-59 year cohort, 1.3% in the 60-69 year cohort, 3.9% in the 70-79 year cohort and 9.8% in the 80-89 year cohort. The incidence rate in the study was 4.9‰/year. The mean annual increase in mean transvalvular pressure gradient was 3.2 mm Hg. The increase was lower in mild AS than in more severe disease, disclosing a non-linear development of the gradient, but with large individual variations. Mortality was not significantly increased in the asymptomatic AS-group (HR = 1.28), nor in those who received aortic valve replacement (n = 34, HR = 0.93), compared with the general population.This is the first study to document the incidence and prognosis of AS in a general population with surgery as a treatment option. It reveals an accelerated progression of the aortic mean gradient as the disease advances. The prognosis of AS seems to be comparable with the normal population in the asymptomatic stage and after successful surgery, indicating that the follow-up and timing of surgery has been adequate for this patient group.CONCLUSIONThis is the first study to document the incidence and prognosis of AS in a general population with surgery as a treatment option. It reveals an accelerated progression of the aortic mean gradient as the disease advances. The prognosis of AS seems to be comparable with the normal population in the asymptomatic stage and after successful surgery, indicating that the follow-up and timing of surgery has been adequate for this patient group. Objective To assess prevalence, incidence, prognosis and progression of degenerative valvular aortic stenosis (AS). Setting The Tromsø Study and the University Hospital of North Norway. Design Population based prospective study. Population Over a 14 year span we performed three repeated echocardiographic examinations (1994, 2001 and 2008) of a random sample of initially 3273 participants. Data from the only hospital serving this population were included. Results There were 164 subjects with AS. Prevalence consistently increased with age, average values being 0.2% in the 50-59 year cohort, 1.3% in the 60-69 year cohort, 3.9% in the 70-79 year cohort and 9.8% in the 80-89 year cohort. The incidence rate in the study was 4.9â[euro]°/year. The mean annual increase in mean transvalvular pressure gradient was 3.2 mm Hg. The increase was lower in mild AS than in more severe disease, disclosing a non-linear development of the gradient, but with large individual variations. Mortality was not significantly increased in the asymptomatic AS-group (HR=1.28), nor in those who received aortic valve replacement (n=34, HR=0.93), compared with the general population. Conclusion This is the first study to document the incidence and prognosis of AS in a general population with surgery as a treatment option. It reveals an accelerated progression of the aortic mean gradient as the disease advances. The prognosis of AS seems to be comparable with the normal population in the asymptomatic stage and after successful surgery, indicating that the follow-up and timing of surgery has been adequate for this patient group. Objective To assess prevalence, incidence, prognosis and progression of degenerative valvular aortic stenosis (AS). Setting The Tromsø Study and the University Hospital of North Norway. Design Population based prospective study. Population Over a 14 year span we performed three repeated echocardiographic examinations (1994, 2001 and 2008) of a random sample of initially 3273 participants. Data from the only hospital serving this population were included. Results There were 164 subjects with AS. Prevalence consistently increased with age, average values being 0.2% in the 50–59 year cohort, 1.3% in the 60–69 year cohort, 3.9% in the 70–79 year cohort and 9.8% in the 80–89 year cohort. The incidence rate in the study was 4.9‰/year. The mean annual increase in mean transvalvular pressure gradient was 3.2 mm Hg. The increase was lower in mild AS than in more severe disease, disclosing a non-linear development of the gradient, but with large individual variations. Mortality was not significantly increased in the asymptomatic AS-group (HR=1.28), nor in those who received aortic valve replacement (n=34, HR=0.93), compared with the general population. Conclusion This is the first study to document the incidence and prognosis of AS in a general population with surgery as a treatment option. It reveals an accelerated progression of the aortic mean gradient as the disease advances. The prognosis of AS seems to be comparable with the normal population in the asymptomatic stage and after successful surgery, indicating that the follow-up and timing of surgery has been adequate for this patient group. To assess prevalence, incidence, prognosis and progression of degenerative valvular aortic stenosis (AS). The Tromsø Study and the University Hospital of North Norway. Population based prospective study. Over a 14 year span we performed three repeated echocardiographic examinations (1994, 2001 and 2008) of a random sample of initially 3273 participants. Data from the only hospital serving this population were included. There were 164 subjects with AS. Prevalence consistently increased with age, average values being 0.2% in the 50-59 year cohort, 1.3% in the 60-69 year cohort, 3.9% in the 70-79 year cohort and 9.8% in the 80-89 year cohort. The incidence rate in the study was 4.9‰/year. The mean annual increase in mean transvalvular pressure gradient was 3.2 mm Hg. The increase was lower in mild AS than in more severe disease, disclosing a non-linear development of the gradient, but with large individual variations. Mortality was not significantly increased in the asymptomatic AS-group (HR = 1.28), nor in those who received aortic valve replacement (n = 34, HR = 0.93), compared with the general population. This is the first study to document the incidence and prognosis of AS in a general population with surgery as a treatment option. It reveals an accelerated progression of the aortic mean gradient as the disease advances. The prognosis of AS seems to be comparable with the normal population in the asymptomatic stage and after successful surgery, indicating that the follow-up and timing of surgery has been adequate for this patient group. |
| Author | Lunde, Per Rasmussen, Knut Heggelund, Geir Eveborn, Gry Wisthus Schirmer, Henrik |
| Author_xml | – sequence: 1 givenname: Gry Wisthus surname: Eveborn fullname: Eveborn, Gry Wisthus email: gry.eveborn@unn.no organization: Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway – sequence: 2 givenname: Henrik surname: Schirmer fullname: Schirmer, Henrik email: gry.eveborn@unn.no organization: Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway – sequence: 3 givenname: Geir surname: Heggelund fullname: Heggelund, Geir email: gry.eveborn@unn.no organization: Department of Heart Disease, Division of Cardiothoracic and Respiratory Medicine, University Hospital of Northern Norway, Tromsø, Norway – sequence: 4 givenname: Per surname: Lunde fullname: Lunde, Per email: gry.eveborn@unn.no organization: Department of Heart Disease, Division of Cardiothoracic and Respiratory Medicine, University Hospital of Northern Norway, Tromsø, Norway – sequence: 5 givenname: Knut surname: Rasmussen fullname: Rasmussen, Knut email: gry.eveborn@unn.no organization: Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/22942293$$D View this record in MEDLINE/PubMed |
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| Cites_doi | 10.1016/j.jtcvs.2011.09.075 10.1093/ije/dyr049 |
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| References | Kurtz, Otto 2010; 89 Minners, Allgeier, Gohlke-Baerwolf 2010; 96 Rosenhek, Rader, Loho 2004; 110 Chan, Teo, Dumesnil 2010; 121 Otto, Burwash, Legget 1997; 95 Cowell, Newby, Prescott 2005; 352 Kang, Park, Rim 2010; 121 Roberts, Ko 2005; 111 Rosenhek, Binder, Porenta 2000; 343 Parolari, Tremoli, Cavallotti 2011; 97 Minners, Allgeier, Gohlke-Baerwolf 2008; 29 Pellikka, Sarano, Nishimura 2005; 111 Otto, Kuusisto, Reichenbach 1994; 90 Schirmer, Lunde, Rasmussen 2000; 21 Nkomo, Gardin, Skelton 2006; 368 Jacobsen, Eggen, Mathiesen 21 April 2011 Lindroos, Kupari, Heikkila 1993; 21 Stewart, Siscovick, Lind 1997; 29 Baumgartner, Hung, Bermejo 2009; 10 Leon, Smith, Mack 2010; 363 Malouf, Le Tourneau, Pellikka 13 February 2012 Schwarz, Baumann, Manthey 1982; 66 Rossebo, Pedersen, Boman 2008; 359 Rosenhek, Zilberszac, Schemper 2010; 121 Murphy, Lawson, Starr 1981; 64 Ross, Braunwald 1968; 38 Schueler, Hammerstingl, Sinning 2010; 96 Iivanainen, Lindroos, Tilvis 1996; 78 |
| References_xml | – volume: 21 start-page: 1376 year: 2000 article-title: Mitral flow derived Doppler indices of left ventricular diastolic function in a general population; the Tromso study publication-title: Eur Heart J – volume: 352 start-page: 2389 year: 2005 article-title: A randomized trial of intensive lipid-lowering therapy in calcific aortic stenosis publication-title: N Engl J Med – volume: 343 start-page: 611 year: 2000 article-title: Predictors of outcome in severe, asymptomatic aortic stenosis publication-title: N Engl J Med – volume: 64 start-page: II184 year: 1981 article-title: Severe aortic stenosis in patients 60 years of age or older: left ventricular function and 10-year survival after valve replacement publication-title: Circulation – year: 13 February 2012 article-title: Aortic valve stenosis in community medical practice: determinants of outcome and implications for aortic valve replacement publication-title: J Thorac Cardiovasc Surg doi: 10.1016/j.jtcvs.2011.09.075 – volume: 97 start-page: 523 year: 2011 article-title: Do statins improve outcomes and delay the progression of non-rheumatic calcific aortic stenosis? publication-title: Heart – volume: 110 start-page: 1291 year: 2004 article-title: Statins but not angiotensin-converting enzyme inhibitors delay progression of aortic stenosis publication-title: Circulation – volume: 111 start-page: 3290 year: 2005 article-title: Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up publication-title: Circulation – volume: 121 start-page: 151 year: 2010 article-title: Natural history of very severe aortic stenosis publication-title: Circulation – volume: 121 start-page: 1502 year: 2010 article-title: Early surgery versus conventional treatment in asymptomatic very severe aortic stenosis publication-title: Circulation – volume: 66 start-page: 1105 year: 1982 article-title: The effect of aortic valve replacement on survival publication-title: Circulation – volume: 111 start-page: 920 year: 2005 article-title: Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation publication-title: Circulation – volume: 95 start-page: 2262 year: 1997 article-title: Prospective study of asymptomatic valvular aortic stenosis. Clinical, echocardiographic, and exercise predictors of outcome publication-title: Circulation – volume: 89 start-page: 349 year: 2010 article-title: Aortic stenosis: Clinical aspects of diagnosis and management, with 10 illustrative case reports from a 25-year experience publication-title: Medicine (Baltimore) – volume: 96 start-page: 1831 year: 2010 article-title: Prognosis of octogenarians with severe aortic valve stenosis at high risk for cardiovascular surgery publication-title: Heart – volume: 21 start-page: 1220 year: 1993 article-title: Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample publication-title: J Am Coll Cardiol – volume: 10 start-page: 1 year: 2009 article-title: Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice publication-title: Eur J Echocardiogr – volume: 78 start-page: 97 year: 1996 article-title: Natural history of aortic valve stenosis of varying severity in the elderly publication-title: Am J Cardiol – volume: 90 start-page: 844 year: 1994 article-title: Characterization of the early lesion of ‘degenerative’ valvular aortic stenosis. Histological and immunohistochemical studies publication-title: Circulation – volume: 29 start-page: 630 year: 1997 article-title: Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study publication-title: J Am Coll Cardiol – volume: 368 start-page: 1005 year: 2006 article-title: Burden of valvular heart diseases: a population-based study publication-title: Lancet – volume: 363 start-page: 1597 year: 2010 article-title: Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery publication-title: N Engl J Med – volume: 359 start-page: 1343 year: 2008 article-title: Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis publication-title: N Engl J Med – year: 21 April 2011 article-title: Cohort profile: the Tromso study publication-title: Int J Epidemiol doi: 10.1093/ije/dyr049 – volume: 38 start-page: 61 issue: 1 Suppl year: 1968 article-title: Aortic stenosis publication-title: Circulation – volume: 96 start-page: 1463 year: 2010 article-title: Inconsistent grading of aortic valve stenosis by current guidelines: haemodynamic studies in patients with apparently normal left ventricular function publication-title: Heart – volume: 121 start-page: 306 year: 2010 article-title: Effect of Lipid lowering with rosuvastatin on progression of aortic stenosis: results of the aortic stenosis progression observation: measuring effects of rosuvastatin (ASTRONOMER) trial publication-title: Circulation – volume: 29 start-page: 1043 year: 2008 article-title: Inconsistencies of echocardiographic criteria for the grading of aortic valve stenosis publication-title: Eur Heart J |
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| Snippet | Objective To assess prevalence, incidence, prognosis and progression of degenerative valvular aortic stenosis (AS). Setting The Tromsø Study and the University... To assess prevalence, incidence, prognosis and progression of degenerative valvular aortic stenosis (AS). The Tromsø Study and the University Hospital of North... To assess prevalence, incidence, prognosis and progression of degenerative valvular aortic stenosis (AS).OBJECTIVETo assess prevalence, incidence, prognosis... |
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| SubjectTerms | Age Age Distribution Aged Aged, 80 and over Aortic Valve - diagnostic imaging Aortic Valve - surgery Aortic Valve Disease Aortic Valve Stenosis - diagnostic imaging Aortic Valve Stenosis - epidemiology Aortic Valve Stenosis - surgery Calcification Cardiac Function Cardiac Remodelling Diastolic Dysfunction Disease Disease Progression Echocardiography Epidemiology Female Follow-Up Studies Haemodynamics Heart Valve Prosthesis Hospitals Humans Incidence Male Medical prognosis Middle Aged Mortality Norway - epidemiology Pathology Patients Population Prevalence Prognosis Prospective Studies Public Health Severity of Illness Index Studies Survival analysis Survival Rate - trends Systolic Dysfunction |
| Title | The evolving epidemiology of valvular aortic stenosis. The Tromsø Study |
| URI | http://heart.bmj.com/content/99/6/396.full https://api.istex.fr/ark:/67375/NVC-8TN4652L-X/fulltext.pdf https://www.ncbi.nlm.nih.gov/pubmed/22942293 https://www.proquest.com/docview/1780725395 https://www.proquest.com/docview/1291607662 |
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