Materiały źródłowe

• #1 Aortic Insufficiency – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557428/

  The Framingham Heart Study was a prospective epidemiologic study that began in 1948 as a means of determining risk factors for coronary heart disease. The original study cohort included 5,209 men and women from 28 to 62 years of age. In this patient cohort, aortic insufficiency had a prevalence of 4.9%, and 0.5% of patients were found to have moderate or greater severity AR. The incidence and severity of aortic insufficiency increased with age, peaked in the fourth to sixth decades of life, occurs in 2% of people older than 70 years of age, and has been seen in 13% of men and 8.5% of women in the Framingham offspring study analyses. The presentation of aortic insufficiency globally varies between industrialized countries and developing countries. Aortic insufficiency can often be seen in industrialized countries more commonly in older patients as a consequence of degenerative, insidious disease processes and linked to patients’ comorbidities that put them at risk for developing AR. In developing countries, AR can present more commonly in younger patients with rapid onset, and rheumatic heart disease and infective endocarditis are two major contributors to AR development. Figures on the frequency of AR globally differ based on sex and geographic location.

• #1 Aortic regurgitation epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Aortic_regurgitation_epidemiology_and_demographics

  The prevalence of aortic regurgitation varies with age, geographic location, and gender. aortic regurgitation is unusual before the age of 50 and then increases progressively later in life. Worldwide the most common cause of aortic regurgitation is the rheumatic heart disease, particularly in the Asia, the Middle East, and the North Africa. In the United States, senile degenerative calcific aortic valve disease and bicuspid aortic valve disease are the most common causes. […] The Framingham Heart Study, a prospective epidemiological study, evaluated the prevalence and severity of aortic regurgitation and other valvular diseases by color Doppler examinations in 1,696 men and 1,893 women. The study revealed that the prevalence of aortic regurgitation (ranging in severity from trace to moderate regurgitation) is 13.0% in men and 8.5% in women.

• #1 Epidemiology of aortic valve stenosis (AS) and of aortic valve incompetence (AI): is the prevalence of AS/AI similar in different parts of the world?

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-18/epidemiology-of-aortic-valve-stenosis-as-and-of-aortic-valve-incompetence-ai

  There are large differences in the epidemiology of aortic valve disease between high-income and low-income countries. […] The prevalence is between 46 per 100,000 in northern India and 2,400 per 100,000 in the Solomon Islands. […] The prevalence of severe aortic stenosis in those aged 75 years is 3.4% in Europe and the USA. […] The epidemiology of aortic valve disease varies enormously between high-income and low-income countries. […] The number of cases of aortic valvular disease will increase because of the strong association between valvular disease and age, combined with the rapid ageing of populations worldwide. […] The burden of rheumatic heart disease (RHD) falls disproportionately on low-income countries and in low-income groups in high-income countries. […] The incidence of acute rheumatic fever has been difficult to establish globally.

• #1 Epidemiology of aortic valve stenosis (AS) and of aortic valve incompetence (AI): is the prevalence of AS/AI similar in different parts of the world?

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-18/epidemiology-of-aortic-valve-stenosis-as-and-of-aortic-valve-incompetence-ai

  In Africa, ARF is still seen regularly in its most fulminant form, affecting children as young as six years old. […] The highest prevalence of RHD is in sub-Saharan Africa with a prevalence of 5.7 per 1,000, compared with 1.8 per 1,000 in North Africa, and 0.3 per 1,000 in economically developed countries was established. […] A review of recent studies predominantly using echocardiography for the diagnosis of chronic RHD shows wide global variations in prevalence, between 46 per 100,000 in northern India and 2,400 per 100,000 in the Solomon Islands. […] Projections in high-income countries uniformly predict an increase in the burden of disease. […] The high prevalence of risk factors for CAVD such as hypertension and increasing life expectancy, mean that there is likely to be a substantial future burden of CAVD in low-income countries.

• #1 Aortic Regurgitation: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/150490-overview

  Although rheumatic heart disease is overall the most common cause of AR worldwide, congenital and degenerative valve abnormalities are the most common cause in the United States, with the age of detection peaking at 40-60 years. Estimates of the prevalence of AR of any severity range from 2-30%, but only 5-10% of patients with AR have severe disease, resulting in an overall prevalence of severe AR of less than 1% in the general population. […] In the Framingham study (with an original cohort of 5209 patients aged 28-62 y and an additional cohort of 5124 patients), AR of any severity was found in 13% of men and 8.5% of women. […] Prevalence and severity increased with age; when stratified by decades of life, AR of moderate or greater severity was seen in less than 1% of patients in all strata younger than 70 years.

• #1 Incidence and Pathology of Aortic Regurgitation | ICR Journal

  https://www.icrjournal.com/articles/incidence-and-pathology-aortic-regurgitation?language_content_entity=en

  Aortic regurgitation (AR) is the third most common valvular heart disease, with a higher relative incidence in men (19.7 per 100,000 person-years) than women (10.8 per 100,000 person-years). The prevalence and severity of AR increase with age, so the AR burden is expected to increase due to demographic ageing. Notably, AR can remain asymptomatic or misinterpreted, leading to underestimation of the actual frequency. Undiagnosed mild and moderate AR has been observed in 814% of elderly patients with no known valvular heart disease in the UK. Severe AR was present in 2%. A recent report from the Society of Thoracic Surgeons database shows that AR accounts for 7% of all surgical aortic valve replacement (SAVR) procedures, which implies that aortic stenosis (AS) remains the principal indication for surgery. This is partly explained by AS being two to three times more prevalent in the general population. However, it may also reflect AR underdiagnosis and misinterpretation. Delayed or missed diagnoses of AR lead to progressive left ventricular (LV) dilatation and decline in ejection fraction, which are common reasons to defer SAVR. This underscores a need for good diagnostic tools and clinical awareness to ensure timely diagnosis of AR.

• #1 Aortic regurgitation epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Aortic_regurgitation_epidemiology_and_demographics

  The prevalence of aortic regurgitation increases with age. It is infrequent in young patients, and occurs in 1% of subjects under the age of 70. However people with congenital aortic valve/root defects such as bicuspid aortic valve disease and Marfan syndrome may develop aortic regurgitation much earlier in life. […] aortic regurgitation is more common in men than in women. In the Framingham heart population cohort study, aortic regurgitation (more than or equal to trace severity on echocardiography) was observed in 13 percent of men and 8.5 percent of women. The higher prevalence of marfan syndrome and bicuspid aortic valve in males could explain in part the greater prevalence of aortic regurgitation in men. […] The prevalence of aortic regurgitation does not show any variation by race in United States. However, internationally there is significant variation in the prevalence of predisposing conditions such as rheumatic heart disease which is more common in the Asia, the Middle East, and the North Africa.

• #1 Clinical manifestations and diagnosis of chronic aortic regurgitation in adults – UpToDate

  https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-chronic-aortic-regurgitation-in-adults

  Aortic regurgitation (AR, also called aortic insufficiency) is caused by inadequate closure of the aortic valve leaflets. It can be induced either by disease of the aortic valve leaflets or by distortion or dilation of the aortic root and ascending aorta. […] This topic will review the causes, epidemiology, pathophysiology, and major clinical features of chronic AR. […] EPIDEMIOLOGY […] At least trace AR by color Doppler echocardiography is common, even in healthy subjects. A study from the Framingham Heart Study found that, in a population-based cohort, AR of at least trace severity on color Doppler echocardiography was present in 13 percent of men and 8.5 percent of women. […] The prevalence of AR varied with age and disease severity. More than trace AR was unusual before age 50 and then increased progressively. […] For mild AR, the prevalence was 3.7, 12.1, and 12.2 percent in men at ages 50 to 59, 60 to 69, and 70 to 83, respectively. The comparable values in women were 1.9, 6.0, and 14.6 percent.

• #1 Incidence and Pathology of Aortic Regurgitation | ICR Journal

  https://www.icrjournal.com/articles/incidence-and-pathology-aortic-regurgitation?language_content_entity=en

  The aetiology of AR may be diverse, encompassing degenerative (degeneration of aortic root and/or aortic leaflet), congenital, inflammatory and infectious factors. The AR mechanism can be primary with aortic valve leaflet abnormality, secondary with preserved aortic leaflets such as aortic root or annular dilatation, or a combination. […] AR is the third most common valvular heart disease, and its burden is expected to rise due to demographic ageing. Managing AR remains challenging due to complexities in patient selection, diagnosis and evolving treatment strategies. A thorough understanding of the diverse aetiologies, from primary leaflet disease to secondary aortopathy, along with the distinct pathophysiological mechanisms of acute and chronic AR, is essential for optimising current management and guiding future therapeutic advancements.

• #1 Aortic Regurgitation | Concise Medical Knowledge

  https://www.lecturio.com/concepts/aortic-regurgitation/

  Aortic regurgitation: most common cause of AR worldwide. […] In developed countries, the most common causes are: aortic root dilation, congenital bicuspid aortic valve, calcific aortic valve disease. […] Prevalence increases in patients 50 years of age.

• #1 Bicuspid Aortic Valve: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/893523-overview

  Bicuspid aortic valves may be present in as many as 1-2% of the population. Because the bicuspid valve may be entirely silent during infancy, childhood, and adolescence, these incidence figures may be underestimated and are not generally included in the overall incidence of congenital heart disease. […] A recent report suggests much lower than expected prevalence in African-Americans. […] The male-to-female ratio is 2:1 or greater. […] A recent prospective echocardiographic study in newborn infants showed a prevalence of bicuspid aortic valve in 7.1 per 1,000 male newborns versus 1.9 per 1,000 female newborns. […] Bicuspid aortic valve may be identified in patients of any age, from birth through the 11th decade of life. […] Critical aortic stenosis and infective endocarditis may be considered relatively early sources of morbidity for patients with bicuspid aortic valve.

• #1 Advances and Challenges in Aortic Regurgitation – Cardiac Interventions Today

  https://citoday.com/articles/2025-mar-apr/advances-and-challenges-in-aortic-regurgitation?c4src=home

  Aortic regurgitation (AR) presents significant diagnostic and therapeutic challenges due to its multifactorial etiology, which can involve the valve alone or in conjunction with a dilated aortic root. […] Although the global burden of rheumatic heart disease has significantly declined due to improved health care access and the advent of antibiotic prophylaxis, it continues to be a leading cause of AR in low- and middle-income countries with fragile health care systems. […] In high-income countries, AR is the third most frequent nonrheumatic valvular heart disease, observed in 1.1% to 1.8% of individuals aged 60 years. […] Approximately 30% of patients with bicuspid valve disease have moderate or greater AR at first presentation. […] As life expectancy increases, the overall prevalence of degenerative AR is likely to rise, underscoring the importance of early detection and effective management strategies.

• #1 Aortic Regurgitation | Doctor

  https://patient.info/doctor/aortic-regurgitation-pro

  Rheumatic heart disease is the most common cause of aortic regurgitation throughout the world. […] In developed countries, congenital and degenerative valve abnormalities are the most common cause and the peak age of presentation is 40-60 years. […] Estimates of the prevalence of AR of any severity range from 2-30% but only a minority of patients with AR have severe disease. […] Moderate or severe AR is common after transcatheter aortic valve replacement.

• #1 Epidemiology of aortic valve stenosis (AS) and of aortic valve incompetence (AI): is the prevalence of AS/AI similar in different parts of the world?

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-18/epidemiology-of-aortic-valve-stenosis-as-and-of-aortic-valve-incompetence-ai

  In general, women are also more likely to have smaller annular sizes and left ventricular (LV) outflow tract dimensions associated with concentric LV hypertrophy. […] Aortic regurgitation (AR) can be due to a primary cause such as bicuspid valve or secondary to aortic root dilatation. […] Moderate or more severe AR was estimated to be prevalent in approximately 0.5% of the total USA population. […] In developing countries, aortic valvular stenosis or regurgitation are typically caused by rheumatic heart disease or infective endocarditis. […] The magnitude of cardiovascular disease is vastly different in different countries (Africa, Asia, Europe or North America) and it shows differences according to sex.

• #1 Heart valve disease module 1: epidemiology – The British Journal of Cardiology

  https://bjcardio.co.uk/2016/03/heart-valve-disease-module-1-epidemiology-2/4/

  In industrially underdeveloped regions, rheumatic disease remains the most common cause. […] In the industrially-developed regions and in the elderly throughout the world, aortic valve disease is predominantly a result of calcific disease. […] The frequency of aortic regurgitation increases with age. Aortic regurgitation of any degree occurred in 29% and severe regurgitation in 13% in the Helsinki Ageing Study. […] Functional aortic regurgitation results from dilatation of the aortic root usually as a result of arteriosclerosis or medial necrosis. […] The risk factors for aortic dilatation are: age, weakness of the aortic wall, the arteriosclerotic risk factors: hypertension; dyslipidaemia; smoking; and diabetes. […] Bicuspid aortic valve should be regarded as a general thoracic aortopathy and is associated with significant dilatation of the aorta (40 mm) in about 20% of cases.

• #1 The Global Burden of Valvular Heart Disease: From Clinical Epidemiology to Management

  https://www.mdpi.com/2077-0383/12/6/2178

  Aortic regurgitation (AR) is the fourth VHD in the world, but in developed countries, where rheumatic fever is rare, it reaches the third position in the group of non-rheumatic VHD. The prevalence is variable, probably due to an underdetection of asymptomatic patients, reaching 1.6% among United Kingdom (UK) subjects aged >65 years old and 4.9% among participants in the United States Framingham study. The true prevalence in resource-poor, developing countries is challenging to obtain due to the limited access to echocardiography. […] The most common causes of AR in Western countries are congenital BAV and the calcific degeneration of leaflets. While men diagnosed with BAV are more likely to develop AS, women principally develop AR, and about 30% of patients with BAV are diagnosed with moderate–severe regurgitation. Hypertension—in particular, diastolic hypertension—is recognized as a risk factor for both aortic root dilatation and valve regurgitation.

• #1 The Global Burden of Valvular Heart Disease: From Clinical Epidemiology to Management

  https://www.mdpi.com/2077-0383/12/6/2178

  According to Yang et al., the risk factors associated with the progression of regurgitation are the male sex, a younger age at diagnosis, the presence of BAV, a larger effective regurgitant orifice and a greater regurgitant volume, and the dilation of the aortic annulus and sinotubular junction. […] While there is no medical therapy that is able to modify the progression of AR, in Marfan syndrome and in BAV, the use of losartan associated with atenolol seems to reduce the rate of dilatation of the aortic root.

• #1 Echocardiographic assessment of aortic regurgitation: a practical guideline from the British Society of Echocardiography | Echo Research & Practice | Full Text

  https://echo.biomedcentral.com/articles/10.1186/s44156-024-00067-8

  Aortic regurgitation is the third most common valve lesion with increasing prevalence secondary to an ageing population. […] Aortic regurgitation (AR) is the third most common valve lesion accounting for approximately 5% of adults undergoing intervention for severe valvular heart disease. […] Echocardiography is central to the diagnosis, monitoring, and clinical decision-making of patients with AR. […] The intended benefit of this supplementary document is to support echocardiographers to perform a comprehensive standardised protocol for the assessment of AR in adult patients. […] Patients with variant anatomy should have particular attention paid to aortic dimensions, should be enrolled in echocardiographic surveillance, and family screening should be offered. […] Irrespective of the presence or absence of valve dysfunction, all patients with variant anatomy should undergo echocardiographic surveillance owing to the high risk of disease progression.

• #1 Chronic aortic regurgitation: diagnosis and therapy in the modern era

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-18/chronic-aortic-regurgitation-diagnosis-and-therapy-in-the-modern-era

  Serial echocardiograms should be performed every 12 months for asymptomatic patients with severe AR and LV end-diastolic size of 60-65 mm and normal LV systolic function. […] The ESC guidelines also suggest reporting the indexed LV end-systolic dimensions (ESD) to accurately identify chamber enlargement in individuals with small body size, specifically in women and elderly patients because non-indexed dimensions are less likely to meet surgical indications in this cohort. […] The presence of symptoms is a class I indication for surgical intervention. […] Asymptomatic patients with an EF less than 50% or those who require other cardiac surgeries also meet this class I indication for surgical replacement.

• #1 Echocardiographic assessment of aortic regurgitation: a practical guideline from the British Society of Echocardiography | Echo Research & Practice | Full Text

  https://echo.biomedcentral.com/articles/10.1186/s44156-024-00067-8

  This guideline recommends that all patients with moderate or severe AR undergo both clinical and echocardiographic surveillance: those with moderate AR should be seen every 12-24 months; severe AR not meeting surgical thresholds every 6-12 months. […] The prevalence of AR within the population is increasing. As such the role of transthoracic echocardiography in the identification and assessment of AR becomes increasingly important.

• #1 Echocardiographic assessment of aortic regurgitation: a narrative review | Echo Research & Practice | Full Text

  https://echo.biomedcentral.com/articles/10.1186/s44156-023-00036-7

  For patients with severe AR who do not meet the currently recommended criteria for surgery, regular echocardiographic monitoring is recommended, as serial changes in LV function and dimensions may identify those that are most likely to develop symptoms and need operation in the near future. […] Asymptomatic patients with moderate and severe AR should have echocardiographic assessment on an annual basis, whilst those approaching the thresholds for intervention should be followed up at 36 monthly intervals. […] For patients with mild-to-moderate AR, echocardiographic assessment every 2-3 years is a reasonable timeline of surveillance.

• #1 Variability in surveillance practice for patients with diagnosis of bicuspid aortic valve syndrome | Scientific Reports

  https://www.nature.com/articles/s41598-022-25571-x

  In patients with bicuspid aortic valves, guidelines call for regular follow-up to monitor disease progression and guide intervention. […] Follow-up care for patients with bicuspid aortic valve was highly variable, and surveillance imaging was sparse despite guidelines. […] There is an urgent need for mechanisms to monitor this population with increased risk of progressive valvulopathy and aortopathy. […] Current guidelines from the The American Association for Thoracic Surgery state that the interval for follow-up imaging should be based on severity of disease (especially aortic dilation). […] Overall, follow-up and use of surveillance imaging of the aorta or the aortic valve may be variable despite awareness of guideline recommendations. […] There is an urgent need for systematic surveillance and implementation of clinical follow-up mechanisms to monitor this patient population with increased risk of progressive valvulopathy and aortopathy.

• #1 Echocardiographic assessment of aortic regurgitation: a narrative review | Echo Research & Practice | Full Text

  https://echo.biomedcentral.com/articles/10.1186/s44156-023-00036-7

  Aortic regurgitation (AR) is the third most common native valvular heart disease behind aortic stenosis and mitral regurgitation with a prevalence of approximately 0.5% of the total population, increasing to almost 15% of individuals over the age of 65. […] Severe AR accounts for around 5% of all native valve intervention. […] With an ageing population, it is expected that healthcare professionals will encounter patients with AR increasingly frequently in clinical practice. […] Severe AR is an important cause of morbidity and mortality. […] Left untreated, the risk of death is approximately one third over 10 years, and almost a half of all patients will develop heart failure. […] Even in asymptomatic patients, severe AR carries a noteworthy annual mortality risk of up to 2.2%. […] This narrative review summarises epidemiology and aetiology of AR, the evidence-base regarding echocardiographic assessment of aortic insufficiency, and novel echocardiographic tools that may prove beneficial in patient assessment and management.

• #1 Aortic Regurgitation | Edwards Lifesciences

  https://www.edwards.com/healthcare-professionals/conditions-procedures/aortic-regurgitation

  Aortic regurgitation (AR) is the third most common valvular pathology found in the general population, with a lifetime risk of 13% in men and 8.5% in women.1 […] It is critical to diagnose and treat AR early, as progression is associated with increased mortality risk. Within ten years of diagnosis of severe AR, 75% of patients die or require aortic valve replacement.1-4 […] Rates of progression are determined by a complicated interaction of several variables, including AR severity, aortic root pathology, and the adaptive response of the left ventricle (LV).6 […] Even in asymptomatic severe AR, mortality can be as high as 19% within 6.6 years of diagnosis.1 […] Current U.S. and European guidelines recommend surgical intervention before symptoms develop in severe AR patients with LV dysfunction, primarily based on echocardiographic parameters.9,10

• #1 Aortic Regurgitation Frontier: Management Options and Future Directions – Cardiac Interventions Today

  https://citoday.com/articles/2024-sept-oct/aortic-regurgitation-frontier-management-options-and-future-directions

  Chronic AR leads to slow and progressive changes in cardiac structure and function. Severe asymptomatic AR has a slower progression to LV dysfunction (1.5% yearly) and symptomatic disease (5% yearly). The condition entails a prolonged initial compensated phase (with or without LV dilation) and a late decompensated phase heralded by systolic dysfunction and development of symptoms. The incidence of progression was significantly associated with baseline AR severity, sinotubular junction, and aortic annulus dimensions. Mortality was significantly associated with LV ejection fraction but not end-systolic dimension. Based on this analysis and others, progression to stage C or D AR is estimated to be approximately 2% to 5% yearly, with a more precipitous course in patients with larger aortic sizes and bicuspid valves.

• #1 Aortic Regurgitation | Edwards Lifesciences

  https://www.edwards.com/healthcare-professionals/conditions-procedures/aortic-regurgitation

  Despite the class 1 indication for SAVR, most patients with ssAR do not receive treatment within one year12 […] An adjusted analysis showed patients who underwent SAVR had a 62% reduction in risk of 1-year mortality compared to patients who did not undergo surgery.12 […] All patients with severe valvular heart disease being considered for valve intervention should be evaluated by a multidisciplinary team with either referral to or consultation with a primary or comprehensive valve center.9

• #1 Aortic Regurgitation Frontier: Management Options and Future Directions – Cardiac Interventions Today

  https://citoday.com/articles/2024-sept-oct/aortic-regurgitation-frontier-management-options-and-future-directions

  The treatment strategy for AR is determined by condition severity, presence of symptoms, and LV function. Management options include both medical and surgical/interventional approaches. The goal of medical management is to control symptoms and slow disease progression. This typically involves guideline-directed medical therapy to address LV systolic dysfunction, vasodilators in hypertensive patients, and diuretics to reduce the volume load. […] Intervention should be considered early in the disease course and definitively sought when symptoms or LV dysfunction develop because it confers a significant survival benefit. The primary surgical options are aortic valve replacement and, less commonly, valve repair. Despite the clear benefits of surgical intervention, approximately 20% of patients with severe symptomatic AR and depressed LV function (ejection fraction between 30%-50%) are referred for SAVR.

• #1 Valvular Heart Disease Epidemiology

  https://www.mdpi.com/2076-3271/10/2/32

  Aortic regurgitation is associated with diastolic, but not systolic, hypertension and it has likewise seen a rise in the developed world. […] Aortic regurgitation (AR) is the fourth most common valvular disease in the world. […] Although global estimates are unavailable, AR was detected in 1.6% of UK elders aged > 65 years, 1.8% of Swedes aged > 65 years old, and 1.1% of Chinese citizens aged > 60 years old. […] The age-standardized incidence of AR in Denmark increased from 2000 to 2017, similar to ASVD, though, unlike ASVD, AR is not known to be significantly associated with atherosclerosis. […] The etiologies that are responsible for chronic AR may be extensive, they include rheumatic heart disease (the most common cause in the developing world), IE, myxomatous valve degeneration, congenital valve abnormalities, age-related dilatation of the aorta, aortic dissection, aortitis/aortic root dilatation secondary to syphilis or giant cell arteritis, trauma, systemic hypertension, senile valvular calcifications, drug-induced valvulopathy, ectasia of the aortic annulus, Crohn disease, Whipple disease, and osteogenesis imperfecta.

• #1 NHS England » Guide to implementing patient initiated follow-up and regular surveillance imaging for patients with mild to moderate heart valve disease

  https://www.england.nhs.uk/long-read/guide-to-implementing-pifu-imaging-mild-to-moderate-heart-valve-disease/

  Patient initiated follow-up (PIFU) is key to personalising outpatient care and, by giving patients more control over when they receive care, can reduce unnecessary routine follow-up appointments and free up clinician time for more complex patients. […] This guide outlines a PIFU model of care for patients with mild to moderate heart valve disease (HVD) or following valve intervention who require ongoing surveillance imaging but not necessarily frequent clinician review. […] Patients with HVD are commonly asymptomatic and often require surveillance imaging as part of their routine management. This ensures that any asymptomatic changes to the patients condition are identified and acted on in a timely manner by the heart valve team. […] The number of patients with HVD is predicted to double by 2046, and given the chronic nature of HVD, ageing population, improved access to diagnostics/screening and increasing percutaneous valve implantations, valve surveillance services risk being significantly impacted.

• #1 NHS England » Guide to implementing patient initiated follow-up and regular surveillance imaging for patients with mild to moderate heart valve disease

  https://www.england.nhs.uk/long-read/guide-to-implementing-pifu-imaging-mild-to-moderate-heart-valve-disease/

  Over 70% of patients followed up in one NHS heart valve clinic had non-severe HVD or prosthetic valves (Leeds Teaching Hospitals audit data, 2021); this indicates that reducing the number of consultations for stable patients with mild to moderate HVD or following valve intervention will allow heart valve clinic resources to be directed to those with severe HVD who are at risk of heart failure and death (NICE guidance 2021). […] Heart valve services should take a standardised cardiac network-based approach to ensure equality of services. […] The surveillance imaging pathway ensures that a patient is imaged (predominantly echocardiography) at predetermined time points, under the overarching care of the dedicated heart valve service. This allows the clinician to monitor the patient and treat them in a timely manner should abnormalities be detected.

• #1 NHS England » Guide to implementing patient initiated follow-up and regular surveillance imaging for patients with mild to moderate heart valve disease

  https://www.england.nhs.uk/long-read/guide-to-implementing-pifu-imaging-mild-to-moderate-heart-valve-disease/

  We recommend that there should be a PIFU HVD helpline for patients and/or carers to call should they have questions or develop symptoms. […] A heart valve PIFU service is likely to be a new concept of care in many centres, and like any new service, it should be evaluated on a regular basis to ensure that it is safe, effective, and equitable.

• #2 Aortic Valve Regurgitation: A Comprehensive Review – PubMed

  https://pubmed.ncbi.nlm.nih.gov/29174586/

  Aortic regurgitation (AR) has an estimated prevalence of 4.9% in the Framingham study, with moderate or severe AR occurring in 0.5% of the study population. […] The incidence and severity of AR increases with age, and may occur acutely or as a chronic valvular disease with distinct presentations, natural history and management strategy.

• #2 Aortic Regurgitation: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/150490-overview

  Although rheumatic heart disease is overall the most common cause of AR worldwide, congenital and degenerative valve abnormalities are the most common cause in the United States, with the age of detection peaking at 40-60 years. Estimates of the prevalence of AR of any severity range from 2-30%, but only 5-10% of patients with AR have severe disease, resulting in an overall prevalence of severe AR of less than 1% in the general population. […] In the Framingham study (with an original cohort of 5209 patients aged 28-62 y and an additional cohort of 5124 patients), AR of any severity was found in 13% of men and 8.5% of women. […] Prevalence and severity increased with age; when stratified by decades of life, AR of moderate or greater severity was seen in less than 1% of patients in all strata younger than 70 years.

• #2 Aortic Regurgitation | Doctor

  https://patient.info/doctor/aortic-regurgitation-pro

  Rheumatic heart disease is the most common cause of aortic regurgitation throughout the world. […] In developed countries, congenital and degenerative valve abnormalities are the most common cause and the peak age of presentation is 40-60 years. […] Estimates of the prevalence of AR of any severity range from 2-30% but only a minority of patients with AR have severe disease. […] Moderate or severe AR is common after transcatheter aortic valve replacement.

• #2 Epidemiology of aortic valve stenosis (AS) and of aortic valve incompetence (AI): is the prevalence of AS/AI similar in different parts of the world?

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-18/epidemiology-of-aortic-valve-stenosis-as-and-of-aortic-valve-incompetence-ai

  In general, women are also more likely to have smaller annular sizes and left ventricular (LV) outflow tract dimensions associated with concentric LV hypertrophy. […] Aortic regurgitation (AR) can be due to a primary cause such as bicuspid valve or secondary to aortic root dilatation. […] Moderate or more severe AR was estimated to be prevalent in approximately 0.5% of the total USA population. […] In developing countries, aortic valvular stenosis or regurgitation are typically caused by rheumatic heart disease or infective endocarditis. […] The magnitude of cardiovascular disease is vastly different in different countries (Africa, Asia, Europe or North America) and it shows differences according to sex.

• #2 Aortic Regurgitation | Concise Medical Knowledge

  https://www.lecturio.com/concepts/aortic-regurgitation/

  Aortic regurgitation: most common cause of AR worldwide. […] In developed countries, the most common causes are: aortic root dilation, congenital bicuspid aortic valve, calcific aortic valve disease. […] Prevalence increases in patients 50 years of age.

• #2 Aortic regurgitation epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Aortic_regurgitation_epidemiology_and_demographics

  In developed countries where rheumatic heart disease is rare, aortic regurgitation may be due to bicuspid aortic valve disease or senile degenerative calcific aortic valve disease which may present in the fourth to sixth decade. Endocarditis and aortic dissection are other causes. The prevalence of any aortic regurgitation in the Framingham study was reported to be 4.9%, with regurgitation of moderate or greater severity occurring in 0.5%. […] In developing countries, rheumatic heart disease is the most common cause of aortic regurgitation and may present in second or third decade of life.

• #2 Aortic Valve Regurgitation | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/a/aortic-valve-regurgitation.html

  Aortic valve regurgitation happens more often with age. It can affect anyone. […] Advancing age is a common risk factor for aortic regurgitation. […] You may not have symptoms for many years. […] Chronic aortic valve regurgitation may get worse. It may need surgery. […] See your healthcare provider regularly to monitor your aortic valve regurgitation. If your symptoms are severe or get worse, see your healthcare provider right away.

• #2 Echocardiographic assessment of aortic regurgitation: a narrative review | Echo Research & Practice | Full Text

  https://echo.biomedcentral.com/articles/10.1186/s44156-023-00036-7

  For patients with severe AR who do not meet the currently recommended criteria for surgery, regular echocardiographic monitoring is recommended, as serial changes in LV function and dimensions may identify those that are most likely to develop symptoms and need operation in the near future. […] Asymptomatic patients with moderate and severe AR should have echocardiographic assessment on an annual basis, whilst those approaching the thresholds for intervention should be followed up at 36 monthly intervals. […] For patients with mild-to-moderate AR, echocardiographic assessment every 2-3 years is a reasonable timeline of surveillance.

• #2 Incidence and Pathology of Aortic Regurgitation | ICR Journal

  https://www.icrjournal.com/articles/incidence-and-pathology-aortic-regurgitation?language_content_entity=en

  The aetiology of AR may be diverse, encompassing degenerative (degeneration of aortic root and/or aortic leaflet), congenital, inflammatory and infectious factors. The AR mechanism can be primary with aortic valve leaflet abnormality, secondary with preserved aortic leaflets such as aortic root or annular dilatation, or a combination. […] AR is the third most common valvular heart disease, and its burden is expected to rise due to demographic ageing. Managing AR remains challenging due to complexities in patient selection, diagnosis and evolving treatment strategies. A thorough understanding of the diverse aetiologies, from primary leaflet disease to secondary aortopathy, along with the distinct pathophysiological mechanisms of acute and chronic AR, is essential for optimising current management and guiding future therapeutic advancements.

• #3 Aortic regurgitation epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Aortic_regurgitation_epidemiology_and_demographics

  In developed countries where rheumatic heart disease is rare, aortic regurgitation may be due to bicuspid aortic valve disease or senile degenerative calcific aortic valve disease which may present in the fourth to sixth decade. Endocarditis and aortic dissection are other causes. The prevalence of any aortic regurgitation in the Framingham study was reported to be 4.9%, with regurgitation of moderate or greater severity occurring in 0.5%. […] In developing countries, rheumatic heart disease is the most common cause of aortic regurgitation and may present in second or third decade of life.

• #3 Chronic aortic regurgitation: diagnosis and therapy in the modern era

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-18/chronic-aortic-regurgitation-diagnosis-and-therapy-in-the-modern-era

  Aortic regurgitation (AR) is a complex and multifactorial valvular disease. […] In the Euro Heart Survey, AR with a grade 2/4 was detected in 10.4% of the study cohort, while the Framingham Heart Study revealed that the overall prevalence of AR detected by colour Doppler echocardiography of any grade was 13.0% in men and 8.5% in women. […] Prevalence and severity increase with age and AR is frequently underdiagnosed. […] Chronic AR generally evolves slowly and imposes a combined volume (manifested by LV enlargement) and pressure overload (indicated by increased end-systolic pressure) on the LV. […] The onset of symptoms (spontaneous or on exercise testing) represents a key development and denotes the strongest indication for intervention. […] Once a diagnosis of severe regurgitation is established, clinical surveillance and periodic echocardiography with TTE is currently the method of choice to assess the progression of the haemodynamic consequences on LV size and function, because significant LV dysfunction may occur before the patient becomes symptomatic.

• #4 Aortic Regurgitation | Edwards Lifesciences

  https://www.edwards.com/healthcare-professionals/conditions-procedures/aortic-regurgitation

  Aortic regurgitation (AR) is the third most common valvular pathology found in the general population, with a lifetime risk of 13% in men and 8.5% in women.1 […] It is critical to diagnose and treat AR early, as progression is associated with increased mortality risk. Within ten years of diagnosis of severe AR, 75% of patients die or require aortic valve replacement.1-4 […] Rates of progression are determined by a complicated interaction of several variables, including AR severity, aortic root pathology, and the adaptive response of the left ventricle (LV).6 […] Even in asymptomatic severe AR, mortality can be as high as 19% within 6.6 years of diagnosis.1 […] Current U.S. and European guidelines recommend surgical intervention before symptoms develop in severe AR patients with LV dysfunction, primarily based on echocardiographic parameters.9,10

Zobacz więcej