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

Abstract

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.

Impact of Moderate to Severe Mitral and Tricuspid Valves Regurgitation after Transcatheter Aortic Valve Implantation: A Multicenter Retrospective Study

“…In our cohort, 4.9% of the patients had concomitant moderate/severe MR and 8% had concomitant moderate/severe TR. The key findings of our analysis are summarized in the following: (1) Moderate/severe TR was associated with higher all-cause mortality at 1-year follow up; (2) Moderate to severe MR did not affect mortality at follow up; (3) Neither significant MR nor TR affected the TAVI procedure success or in-hospital death; (4) In multivariate analysis, moderate/severe TR was associated with 2-fold higher mortality at 1-year follow up.…”

“…The most common valve heart disease in the western world is degenerative aortic valve stenosis (AS) (1). A significant proportion of patients receiving transcatheter aortic valve implantation (TAVI) have moderate or severe mitral regurgitation (MR) and/or tricuspid regurgitation (TR).…”

Diagnostic accuracy of heart auscultation for detecting valve disease: a systematic review

“…This probably increases sensitivity for auscultation as the prevalence of more advanced disease is higher in such patient samples. Only two studies were done on an unselected population (Gardezi et al and Steeds et al ) 23 24…”

Potential role of conventional and speckle-tracking echocardiography in the screening of structural and functional cardiac abnormalities in elderly individuals: Baseline echocardiographic findings from the LOOP study

“…Accordingly, the prevalence of significant AS in our study falls well in line with that reported in the ARIC study of 0.7% [ 51 ]. Even though some have argued for opportunistic screening for aortic valve disease [ 53 ], the cost-benefit of screening and following elderly at-risk patients with aortic sclerosis in unclear. Follow-up echocardiographic examinations in the LOOP study have now been concluded and may help to illustrate the extent to which aortic sclerosis progresses to AS in these participants.…”