Chronic non-rheumatic aortic valvular disease: A population study based on autopsies

Clinical information has low sensitivity for postmortem diagnosis of heart valve disease

“…However, in the present study, we demonstrate that there remain a small number of septuagenarians and octogenarians with a BAV who do not undergo valve replacement and die of other causes. These findings would be consistent with an older autopsy study, which demonstrated a BAV which did not contribute to the cause of death in 0.8% of men and 0.2% of women aged 65 years and older 17. Improved understanding of BAV pathophysiology and identification of individuals who appear to be safeguarded from rapid disease progression may facilitate investigation of mechanisms that protect against valve calcification18 and stimulate efforts to generate disease-modifying therapies for aortic stenosis.…”

“…While we did not exclude those undergoing consented post-mortems, most autopsies are requested by the coroner to investigate sudden and unexplained deaths which may increase the proportion with undiagnosed VHD as a cause. A perhaps more representative national population analysis (albeit from a different era) is provided from Iceland, where 30% of individuals underwent postmortem examination from 1966 to 1974 (a third for medicolegal reasons)17 demonstrating non-rheumatic calcification of a trileaflet aortic valve in 2.5% (almost identical to the 2.6% in our study). Moreover, autopsy findings may not necessarily be an appropriate gold standard given that the pathophysiological importance of VHD may be difficult (or impossible) to discern on anatomical examination alone.…”

Left-Sided Degenerative Valvular Heart Disease in Type 1 and Type 2 Diabetes

“…Women with diabetes had significantly lower risk for valvular lesions, with the exception of mitral stenosis. Previous epidemiological research suggests that mitral stenosis is more common in women and associated with higher mortality, regardless of ethnic background, 36,37 presumably because of rheumatic heart disease. However, epidemiological reports from the Swedish patient registry show that most of the women who were diagnosed with mitral stenosis did not have a known history of rheumatic heart disease, and the prevalence of rheumatic fever in Sweden is extremely low, 8,9 suggesting that other pathogeneses may be the most important cause of mitral stenosis.…”