Abstract 15265: Trace or Mild Valvular Heart Disease With Cardiac Remodeling, Damage, and Overload in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Abstract

Background: Few studies have evaluated the link between trace or mild valvular disease with measures of cardiac structure, function, and damage in a general population of older adults. Hypothesis: Three left-sided valvular conditions (aortic stenosis, aortic regurgitation, and mitral regurgitation) will be independently associated with cardiac remodeling, damage, and overload. Methods: In 4,935 ARIC participants aged 66-99 years in 2011-13, we examined the cross-sectional associations of these three valvular conditions, only in trace or mild forms, with echocardiographic measures (left ventricular mass index, left ventricular end-diastolic diameter [LVDd], ejection fraction [EF], left atrial volume index [LAVI]) and biomarkers (high sensitivity troponin-T [hs-TnT] and natriuretic peptide) using multivariable linear regression. Aortic stenosis was categorized as none or mild by peak transaortic jet velocity and mean transaortic gradient. Regurgitation was categorized as none, trace, or mild based on color Doppler signal (see the Table footnote for detailed definitions). Results: The prevalence was 4.3% for mild aortic stenosis, 10.8% for aortic regurgitation (10.3% trace, 0.5% mild), and 44.0% for mitral regurgitation (39.9% trace, 4.1% mild). Each valvular condition showed independent and graded associations with all measures tested (Table), with the exception of aortic stenosis with LVDd and aortic regurgitation with hs-TnT. There was a positive association between aortic stenosis and EF. The associations remained consistent when all three valvular conditions were modeled simultaneously. Conclusions: Three prevalent valvular conditions were independently associated with cardiac remodeling, damage, and overload. Although this study cannot determine the directionality of these associations, our results suggest the involvement of mild valvular abnormalities in the pathophysiology of functional and structural alteration of the heart.