PREVASC: prospective registry of epidemiology of valve disease in asymptomatic italian subjects
Authors: Amico M A , Busi G , Vannini M , Bruscoli F , Marchionni N , Boccanelli A , Carrabba N 
Published: June 2024

Background

Valvular heart disease (VHD) is the third most prevalent cardiovascular disease, undergoing notable transformations in both presentation and management in the last years. The advent of percutaneous and minimally invasive interventions has notably altered the landscape of VHD care. Despite reduced prevalence of valve replacements and low mortality rates attributed to valve diseases, emerging evidence challenges their perceived minor public health concern. This study endeavors to delve into the epidemiology of VDH in rural settings, offering an unconventional perspective that underscores the evolving dynamics of its presentation and management.

Methods

This prospective, multicenter registry aims to assess the prevalence of VHD within the Italian population. Screenings were conducted in 10 small villages across Italy, targeting individuals aged over 65 with no prior history of VHD. The data collection encompassed demographic variables, cardiovascular risk factors, and echocardiographic assessments. The initiative aimed to raise awareness of VDH and foster a collaborative approach to healthcare between the scientific community and local authorities, ultimately benefiting the local populace.

Results

Among the 1113 subjects examined, data reveal a close association between an aging population and the prevalence and severity of VHD. Three-quarters of the subjects exhibited at least one valvular defect (839, 75.4%), with this percentage escalating to 87% among those aged ≥75 years. Moderate or severe valvulopathy was identified in 106 patients (9.5%), primarily linked to left-sided VHD (91, 8.2%). Notably, 25.1% of subjects aged ≥75 displayed moderate or severe VHD. Aortic valve stenosis globally manifested at an incidence of 6.4%, with nearly two-thirds of cases (63%) occurring in patients ≥75 years (45, 4%). Mitral regurgitation (MR) was observed in 40.5% of subjects (451), predominantly attributable to degenerative causes (87.5%). Age-stratified analysis of MR revealed substantial equivalence between age groups, but all instances of moderate or severe insufficiencies were identified in subjects aged ≥75 years. Right-sided valvulopathies mirrored similar trends: 667 subjects (60.0%) exhibited tricuspid regurgitation, graded as more than mild in 15 subjects (1.3%), with 13 cases found in the ≥75 years group.

Conclusions

The distinctive rural perspective of this study enriches our comprehension of valvulopathy epidemiology by challenging conventional urban-centric biases. The observed correlation between age and valvulopathy, consistent with broader European registries, underscores the significance of nuanced insights into these conditions. The study's contribution to ongoing discussions on VDH underscores the critical need for tailored awareness campaigns and interventions, particularly in light of the evolving demographic landscape, advocating for nuanced approaches in crafting effective prevention and intervention strategies. AS+MR age-stratified prevalence.