Frequency and natural course of American College of Cardiology/American Heart Association valvular heart disease stages in the general population: results from the population-based STAAB cohort study

BMJ - Heart · 16 hrs ago · 3 views

Background Valvular heart disease (VHD) is described in American guidelines as a progressive disease continuum: stage A (at-risk), stage B (progressive), stage C/D (severe). We aimed to identify frequency and course of VHD stages as well as determinants of VHD progression in the general population. Methods The STAAB cohort study (Characteristics and Course of Heart Failure STAges A/B and Determinants of Progression) recruited a prestratified, population-based sample of residents (30–79 years) from Würzburg, Germany, without self-reported heart failure. Participants underwent baseline transthoracic echocardiography (2013–2017) with follow-up after 3 years (2017–2021). VHD progression was defined as an increase in stage or valve intervention. Results Of 4943 participants (mean age 55 years, 53% women) VHD stages were: 24% no VHD, 54% stage A, 21% stage B and 0.3% stage C/D. Prevalence of VHD increased with advancing age. Among 3833 participants who were followed for a median of 34 months, 10% in stage A and 1.3% in stage B progressed. Progression rates were highest in participants aged 60–69 and 70–79 years, at rates of 15% and 25% for stage A and 1.6% and 2.6% for stage B, respectively. In multivariable age-adjusted models, elevated E/e’ predicted progression from stage A, while elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) predicted progression from stage B. Continuous analysis of aortic stenosis progression showed associations with older age, higher body mass index, diabetes and baseline peak velocity. Conclusion In a large community cohort, VHD was common, especially at older ages, and about 11% of individuals progressed within 3 years. Echocardiographic indices (E/e’) and the biomarker NT-proBNP emerged as stage-specific predictors, supporting their potential role, along with age and metabolic factors, in identifying individuals at higher risk for progression.