Clinical Features Of Common Elderly Valvular Heart Disease

OBJECTIVE: Clinical data of rheumatic,functional and degenerative elderly valvular heart disease was analyzed to investigate and compare the clinical features and related influencing factors of elderly heart valve disease of different causes.METHODS: From January 2015 to December 2016,225 patients who are older than 60 years of age and had been diagnosed with valvular heart disease by echocardiography in the First Affiliated Hospital of Guangxi Medical University were included in the study.Among them,207 patients with common causes were divided into rheumatic heart disease(RHD)group(n = 89),degenerative valvular heart disease(DHVD)group(n = 95),and functional valvular disease(FHVD)group(n = 23).The clinical data of the patients with the three common causes,such as history,blood biochemical indexes,electrocardiogram,chest X-ray and echocardiogram were collected and analyzed to compare the clinical features and related influencing factors of elderly heart valve disease with different causes.RESULTS:(1)Medical history:The age of the elderly patients with heart valve disease in the RHD group,FHVD group and DHVD group was 66.56 ±6.22 years old,70.39 ± 8.0 years old,and 74.41 ± 8.78 years old,P <0.001,the difference was statistically significant.The mean age of the DHVD group wasthe highest,the RHD group was the lowest,and the FHVD group was in the middle.·In the RHD group,the FHVD group and the DHVD group,the number of patients with a history of hypertension less than 5 years was 6(6.7%),5(21.7%),and 13(13.7%),respectively,and the number of patients with a history of hypertension of not less than 5 years was 9(10.1%),11(47.8%),and 40(42.1%),respectively.The prevalence of hypertension of less than five years or not less than five years’ history,or five years and above in the RHD group was lower than that in the FHVD and DHVD groups(P <0.001).There was no significant difference between the three groups in the other data(P> 0.05)such as gender,ethnicity,occupation,body mass index,smoking history,history of diabetes,history of coronary heart disease,history of stroke,and cardiac insufficiency.(2)Comparison of blood biochemical indicators:The differences were not statistically significant in D-dimer,CRP,Tn I,BNP,LDL-C,HCY,serum calcium and other blood biochemical indicators(P> 0.05).(3)ECG:There were 50(56.2%)cases of atrial fibrillation in the RHD group,7(30.4%)in the FHVD group,and 26(27.4%)in the DHVD group,RHD group and DHVD group were statistically significant(P<0.001).The prevalence of atrial fibrillation in RHD group was higher than that in DHVD group.(4)Chest x-ray:There were28(31.5%)cases of pulmonary congestion in the RHD group,2(8.7%)in the FHVD group and 9(9.5%)in the DHVD group.In the RHD group,FHVD group and DHVD group,the number of patients with cardiothoracic ratio of 0.5 and above was 65(73%),14(60.9%)and 38(40%)respectively.RHD group and DHVD group were statistically significant(P all <0.001)in the aspect of pulmonary congestion,cardiothoracic ratio ≥ 0.5.The positive rate of chest X-ray pulmonary congestion and cardiac enlargement in RHD group was higher than that in DHVD group.(5)Echocardiography:(1)Lesions involving thevalve:There were 77(86.5%)patients with lesions in the mitral valve in the RHD group,21patients(91.3%)in the FHVD group,and 68patients(71.6%)in the DHVD group.RHD group and DHVD group were statistically significant(P= 0.013),patients with mitral valvular involvement in the RHD group were more than those in the DHVD group.(2)Distribution of mitral valve lesions: The number of patients with mitral stenosis(MS),mitral stenosis + insufficiency(MS + MI)in the RHD group were 66(74.2%),56(62.9%);0(0%),0(0%)in FHVD group;and 8(8.4%)cases,3(3.2%)cases in DHVD group.The prevalence of MS and MS + MI in the RHD group was much higher than that in the FHVD and DHVD groups(P <0.001).(3)Comparison of MS parameters:There was a difference in the MS distribution between the RHD group and the DHVD group(P = 0.03),the number of patients with mild MS were 10(15.4%),4(47.1%),moderate MS were 18(27.7%),1(14.3%),and severe MS were 37(56.9%),2(28.6%).The prevalence of moderate to severe rheumatic MS was higher than that of degenerative MS,and the prevalence of mild degenerative MS was higher than that of rheumatic MS.The area of the flap was 1.11 ± 0.49cm2 in the RHD group,1.51 ± 0.68cm2 in the DHVD group and the P valueis 0.049.The mean flap area of the rheumatic MS was smaller than that of the degenerate MS.The number of patients with mitral valve adhesion was 57(87.7%)in the RHD group,0(0.0%)in the DHVD group,P <0.001,The prevalence of rheumatic MS was significantly higher than that of mitral valve adhesion.(4)Distribution of MI:In the FHVD group,the number of MI patients was 23(100%),DHVD group 72(75.8%),P = 0.006,all patients in the FHVD group had mitral regurgitation and the prevalence was higher than that of the DHVD group.(5)Aortic valve lesion distribution: The number of patients with aortic stenosis(AS)and aortic insufficiency(AI)in the FHVD groupwere 2(8.7%),14(60.9%),in the DHVD group45(47.4%),80(84.2%),and the prevalence of AS and AI in DHVD group was higher than that in FHVD group(P <0.05).There were 25(28.1%)patients with AS + AI in the RHD group,1(4.3%)in the FHVD group,40(42.1%)in the DHVD group,and there was a significant difference between RHH group and FHVD group,FHVD group and DHVD group.The prevalence of AS + AI in FHVD group was much lower than that in RHD group and DHVD group(P <0.017).(6)Distribution of valvular calcification: There were 47(61%)cases of mitral calcification in the RHD group and 22(32.4%)in the DHVD group and the P value is 0.001;However,there were 25(39.7%)cases of aortic valve calcification in the RHD group,57(74%)in the DHVD group,and the differences of the groups above were statistically significant(P <0.001).The prevalence of mitral calcification in RHD group was higher than that in the DHVD group and the prevalence of aortic valve calcification was lower than that of the DHVD group.(7)Comparison of the structures and functions of each cardiac chamber: the left atrial diameter is52.44±14.68 mm in the RHD group,41.91±6.75 mm in the FHVD group,and41.85±9.27 mm in the DHVD group.The P value of the comparison between RHD group and FHVD group,RHD group and DHVD group was less than0.001;the ventricular septal thickness was 11.12±2.17 mm in the RHD group,11.83±1.83 mm in the FHVD group,and 12.20±2.10 mm in the DHVD group,and there was difference in distribution between the RHD group and the DHVD group,P = 0.001.Left atrial diameter in the patients of the RHD group was greater than that in the FHVD and the DHVD group.The mean ventricular septal thickness in the DHVD group was greater than that in the RHD group.CONCLUSIONS:(1)Common causes of elderly heart valve disease:rheumatic,functional and degenerative valvular disease,of which the averageage of patients from high to low was degenerative,functional,and rheumatic valvular disease.(2)The prevalence of hypertensive in patients with rheumatic valvular heart disease is lower than that in patients with elderly functional and degenerative valvular disease.(3)There were cardiac insufficiency,elevated BNP and dyslipidemia in most elderly patients with valvular heart disease,but there was no difference between the different cause groups.(4)There is a higher prevalence of senile rheumatic valvular disease than degenerative valvular disease in the index of atrial fibrillation and pulmonary congestion.(5)Echocardiography showed that the incidence of involving the mitral valve,resulting in mitral valvular calcification and left atrial enlargement,and causing moderate to severe mitral stenosis and adhesions is higher in elderly rheumatic valvular heart disease than in degenerative heart disease.The prevalence of aortic valve calcification and ventricular septal thickening was lower inelderly rheumatic valvular heart than in degenerative valvular disease.Functional heart valve disease is mainly manifested as valve insufficiency.