VALVUIAR HEART DISEASE Age - related valvular regurgitation : a study by pulsed Doppler echocardiography

To assess the prevalence of valvular regurgitation in the aged, we studied 176 apparently healthy volunteers with no history or physical evidence of cardiac abnormality. Their ages ranged from 40 to 90 (66 ± 14, mean ± SD) years. We examined these subjects by pulsed Doppler echocardiography combined with two-dimensional echocardiography to determine the prevalence of valvular regurgitation. Regurgitation began to appear in subjects in their fifties, increasing in prevalence with advancing age (r = .81, p < .001), and was documented in all over age 80. Similarly, regurgitation involving more than one valve appeared in those 60 years and older, and was very common (89%) in subjects in their eighties. With each type of valvular regurgitation, the prevalence of each type of regurgitation increased with aging, but this tendency was most prominent for aortic regurgitation. We conclude that (1) single or multivalvular regurgitation as detected by pulsed Doppler echocardiography is very common in the aged and may be considered a normal finding in the absence of other evidence of heart disease, and (2) the high prevalence of regurgitation in the aged must be taken into account when Doppler examinations are being performed. Circulation 76, No. 2, 262-265, 1987. PULSED DOPPLER echocardiography is a noninvasive technique that has proved useful in the detection of valvular regurgitation. The high degree of specificity and sensitivity of this technique has been reported. 1 11 The atrioventricular valves are known to become thicker and more opaque with advancing age,12 15 and similar changes may occur in the semilunar valves. The grade of these changes is in part genetically determined and in part age related. 12 16 Therefore, multivalvular regurgitation of little or no clinical significance can be expected to occur in older subjects. The purpose of this study was to investigate the prevalence of valvular regurgitation in the aged by pulsed Doppler echocardiography. Subjects and methods Apparently healthy volunteers without cardiac symptoms were studied. All were outpatients or inpatients of the DepartFrom the Department of Cardiology, Kobe General Hospital, Kobe, Japan. Address for correspondence: Junichi Yoshikawa, M.D., Department of Cardiology, Kobe General Hospital, Minatojima-nakamachi 4-6, Chuo-ku, Kobe 650, Japan. Received Sept. 23, 1986; revision accepted April 2, 1987. Presented in part at the 58th Scientific Sessions of American Heart Association, Washington, D.C., November 1985. ment of Ophthalmology of Kobe General Hospital who were undergoing routine vision testing or were being considered for cataract surgery. None had received a prior diagnosis of cardiac disease or had valvular regurgitation of a known cause such as rheumatic fever, myocardial infarction, hypertension, or mitral valve prolapse. Before the pulsed Doppler echocardiographic study, a physical examination was performed and a 12-lead electrocardiogram as well as a two-dimensional echocardiogram were recorded to exclude known causes of valvular regurgitation. Patients were excluded if they had a significant murmur, atrial fibrillation, left ventricular hypertrophy, evidence of previous myocardial infarction, asynergy of the left ventricle, mitral annular calcification, or a perceptible aortic valve abnormality. Finally, 176 of 227 apparently healthy volunteers were studied by pulsed Doppler echocardiography. Their ages ranged from 40 to 90 (mean + SD, 66 + 14) years. These subjects were divided into five groups according to age. Pulsed Doppler echocardiography was performed with a commercially available bidirectional ultrasonic pulsed Doppler flowmeter (Toshiba SDS-21A) combined with a real-time, phased-array two-dimensional echocardiograph (Toshiba SSH40A). The frequency of the pulsed Doppler flowmeter was 2.4 MHz and the pulse repetition rate was 4 KHz. The samle volume had a teardrop shape and was 2 mm deep and 4 mm wide. The site of sampling volume could be set at any depth from 0 to 16 cm from the transducer and was displayed on the two-dimensional and M mode echocardiograms. The Doppler signal was passed through a high-pass filter (400 Hz) to eliminate the influence of movements of the intracardiac structures. Frequency analysis of the Doppler signals was carried out in real time by fast-Fourier transform. Doppler signals were recorded by a strip-chart recorder at a paper speed of 50 mm/sec along with M mode echocardiograms, electrocardiograms, and phonocardiograms. CIRCULATION 262 by gest on O cber 5, 2017 http://ciajournals.org/ D ow nladed from PATHOPHYSIOLOGY AND NATURAL HISTORY-VALVULAR HEART DISEASE