Queen Elizabeth Hospital & Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
Whaddon Medical Centre, Bletchley, UK.
Open Heart. 2021 May;8(1). doi: 10.1136/openhrt-2021-001640.
Degenerative aortic stenosis (AS), the most common valvular heart disease in the Western world, is often diagnosed late when the mortality risk becomes substantial. We determined the feasibility of AS screening during influenza vaccination at general practitioner (GP) surgeries in the UK.
Consecutive subjects aged >65 years presenting to a GP for influenza vaccination underwent heart auscultation and 2D echocardiography (V-scan). Based on these findings, a patient management strategy was determined (referral to cardiologist, review within own practice or no follow-up measures) and status at 3 months was determined.
167 patients were enrolled with a mean age of 75 years. On auscultation, a heart murmur was detected in 30 of 167 (18%) patients (6 subjects with an AS-specific and 24 with a non-specific murmur). 75.2% of those with no murmur had a negative V-scan finding. Conversely, 16 of 30 (53%) patients with any murmur had an abnormal V-scan finding that was largely related to the aortic valve. Using clinical auscultation and V-scan screening, a decision not to pursue follow-up measures was taken in 147 (88%) cases, whereas 18 (10.8%) subjects were referred onward; with 5 of 18 (27.8%) and 3 of 18 (16.7%) being diagnosed with mild and moderate AS.
Our pilot study confirms feasibility of valvular heart disease screening in the elderly in a primary care setting. Using simple and inexpensive diagnostic measures and 7.3 million UK inhabitants undergoing influenza vaccination, nationwide screening could potentially identify 130 000 patients with moderate AS and a significant number of patients with severe AS.
退行性主动脉瓣狭窄（AS）是西方最常见的瓣膜性心脏病，通常在死亡率显著增加时被诊断为晚期。我们在英国的全科医生（GP）手术中确定了在流感疫苗接种期间进行 AS 筛查的可行性。
连续接受流感疫苗接种的年龄> 65 岁的患者接受心脏听诊和 2D 超声心动图（V 扫描）检查。根据这些发现，确定了患者的管理策略（转介给心脏病专家、在自己的实践中复查或不采取随访措施），并确定了 3 个月时的状态。
167 例患者入组，平均年龄为 75 岁。在听诊时，167 例患者中有 30 例（18%）患者出现心脏杂音（6 例为特定 AS 杂音，24 例为非特异性杂音）。没有杂音的患者中，75.2%的 V 扫描结果为阴性。相反，30 例有任何杂音的患者中有 16 例（53%）的 V 扫描结果异常，主要与主动脉瓣有关。使用临床听诊和 V 扫描筛查，147 例（88%）患者决定不进行随访，18 例（10.8%）患者被转介；18 例中有 5 例（27.8%）和 3 例（16.7%）被诊断为轻度和中度 AS。
我们的初步研究证实了在初级保健环境中对老年人心血管疾病进行筛查的可行性。使用简单且廉价的诊断措施和英国 730 万接受流感疫苗接种的居民，全国范围内的筛查可能会发现 13 万名中度 AS 患者和大量重度 AS 患者。
