Prevalence of asymptomatic valvular heart disease in the elderly population: a community-based echocardiographic study

Aims
With an aging population the presence of asymptomatic valvular heart disease (VHD) in the community remains unknown. To determine the prevalence and associated factors of asymptomatic VHD in individuals ≥60 years old, and to evaluate the feasibility of echocardiographic screening for VHD in this population.
Methods: This was a prospective cohort study conducted between 2007 and 2016 in the United Kingdom. Asymptomatic patients with no prior indication for echocardiography were invited to participate and evaluated with a health questionnaire, clinical examination and transthoracic echocardiography.
Results: Ten thousand individuals were invited through their general practices. A total of 5,429 volunteered to participate, of whom 4,237 were eligible for inclusion. VHD was diagnosed in more than a quarter (28.2%). The most common types of VHD were regurgitation of tricuspid (13.8%), mitral (12.8%) and aortic valve (8.3%) (trivial regurgitation was not included). The prevalence of clinically significant VHD was 2.4% (2.2% moderate and 0.2% severe), with mitral and aortic regurgitation the most common. The only parameter associated with significant VHD was age (OR 1.07 per one year increment, 95% CI 1.05-1.09, p<0.001). The number needed to scan to diagnose one clinically significant case of VHD is 42 for individuals ≥60 and 15 for those ≥75 years old.



Conclusions
Asymptomatic VHD is present in a significant proportion of otherwise healthy individuals without known VHD over 60 years old. Age is strongly associated with an increased incidence of significant VHD.