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The etiology of valvular heart disease has changed radically over the last few decades, evolving from a situation in which rheumatism was its main cause, to the current situation in which a degenerative etiology accounts for the majority of cases. Aortic stenosis (AS) represents the paradigm of degenerative valve disease, being the most frequently diagnosed valvular heart disease and the one associated with the greatest number of surgical interventions.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Population statistics project a large increase in the prevalence of this disease in the elderly Spanish population. Specifically, it is estimated that 11.7 million Spaniards over the age of 65 years will be affected by this condition in 2030, which corresponds to 3 million more individuals than at present. In the context of a steadily aging society, the burden of degenerative disease is expected to increase significantly. Thus, prevalence studies are crucial to implement prevention, healthcare, and healthcare resource optimization measures.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Because the epidemiology of AS has not been clearly established in Spain, the aim of this study is to determine the actual prevalence of undiagnosed AS in a representative sample of the general elderly population.</p><p id="par0015" class="elsevierStylePara elsevierViewall">To minimize a possible selection bias, subjects over the age of 65 years attending two different health centers (reference population of 55,970 people) to receive an influenza vaccination during the 2018 campaign were invited to participate in this study. The protocol consisted in the conduct of a transthoracic echocardiography (supervised by four experienced operators) to detect findings of an aortic valve disease according to the current recommendations of the cardiac imaging societies.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Clinical and analytical data were also collected from all subjects.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A total of 522 subjects, 318 (61%) of whom were women, agreed to participate in the study throughout the two-month study inclusion period. Some degree of AS was detected in 22 (4.21%) of these subjects. The mean age of the participants was 74.8 ± 7.1 years, with subjects with AS being older than those without this disorder. (78.7 ± 6.7 vs. 74.1 ± 7.9 years; <span class="elsevierStyleItalic">P</span> < .01). Surprisingly, only four of the 22 subjects in which the condition was detected had a history of heart murmur recorded in their medical records, and none of them had been examined by a cardiologist.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A diagnosis of aortic sclerosis was established in subjects presenting with valvular degeneration without hemodynamic involvement. This finding was present in 53.4% (n = 279) of all participants, and was detected in 85.1% (n = 40) of those aged >85 years. A similar age dependence was also observed in relation to the prevalence of AS, which was detected in 12.8% (n = 6) of the participants aged 85 years and over. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the prevalence data for aortic sclerosis and AS stratified by age.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Regarding the severity of the cases of AS, ten (1.9%) participants had mild AS, another ten (1.9%) had moderate AS, and two (0.4%) had severe AS. It is important to highlight that 15 (68.2%) participants presenting with AS also had other significant, coexisting, valvular heart diseases, with aortic regurgitation being the most frequent comorbidity (8 participants [36.4%]).</p><p id="par0035" class="elsevierStylePara elsevierViewall">The population of participants with AS had a significant load of cardiovascular risk factors, with 59% of them having arterial hypertension, 50% dyslipidemia, 32% diabetes, and 27% an active or recent smoking habit.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The main finding of our study is the higher prevalence of aortic sclerosis and stenosis in unselected, elderly subjects from the general population compared with the prevalence figures reported previously for Spain.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Consistent with the data recorded in previous registries,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in our study population, AS typically appeared in elderly subjects presenting with a significant load of cardiovascular risk factors.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Although the diagnosis in most cases corresponded to aortic sclerosis or non-severe aortic stenosis, both of which are conditions whose clinical relevance is limited to follow-up according to the current guidelines, we believe the data obtained in our study to be important, as they may help shed light on the epidemiology of a disease that represents, and will continue to represent, a great clinical challenge in the coming years.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ramos Jiménez J, Hernández Jiménez S, Zamorano Gómez JL. Campaña para la detección precoz de estenosis aórtica. Med Clin (Barc). 2021;157:48–49.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1577 "Ancho" => 2917 "Tamanyo" => 191076 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Prevalence of aortic sclerosis and stenosis according to the patient’s age.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B. 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Journal Information
Vol. 157. Issue 3.
Pages 146-147 (August 2021)
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Vol. 157. Issue 3.
Pages 146-147 (August 2021)
Scientific letter
A campaign for early detection of aortic stenosis
Campaña para la detección precoz de estenosis aórtica
Javier Ramos Jiménez
, Sergio Hernández Jiménez, José Luis Zamorano Gómez
Corresponding author
Departamento de Cardiología, CIBERCV, Universidad de Alcalá de Henares, Hospital Ramón y Cajal, Madrid, Spain
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