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.

Abstract (English)

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.