Etiology and distribution of isolated aortic stenosis in Indian patients – A study from a large tertiary care hospital in north India

BACKGROUND: Isolated aortic valve disease (IAVD) has traditionally been a disease of elderly, etiology being either senile degeneration of a tricuspid aortic valve or calcification of a bicuspid aortic valve. However, there is scarcity of Indian data regarding demographic distribution and etiological patterns of IAVD in context of emerging therapies like transcatheter aortic valve implantation (TAVR). METHODS & RESULTS: A retrospective observational analysis of 60,560 echocardiograms over three years revealed 3728 newly diagnosed cases of valvular heart disease (VHD). Isolated mitral valve disease (IMVD) constituted 48.7% (n = 1815) of all VHD, including 1104 (29.6%) cases of pure mitral stenosis (MS) which was the commonest single lesion followed by combined mitral and aortic valve disease (CMAVD) (n = 1320, 34.5%), mixed aortic valve disease (MAVD) (n = 349, 9.4%), isolated aortic stenosis (IAS) (n = 179, 4.8%) and isolated aortic regurgitation (IAR) (n = 75, 2.0%). IAS patients had bimodal age distribution with peaks in first and sixth decade, contributed by congenital and acquired IAS respectively. Acquired IAS comprised of degenerative tricuspid aortic valve (n = 79, 58.1%; mean age: 63.2 ± 8.8 years), bicuspid aortic valve (BAV) (n = 34, 25.0%; mean age: 36.0 ± 8.3 years), rheumatic (n = 4, 2.9%; mean age: 55.3 ± 3.4 years) and non-rheumatic IAS with unclear morphology (n = 19, 14%; mean age: 48.5 ± 9.3 years). 65.6% patients with acquired non-rheumatic isolated aortic stenosis were less than 60 years of age. CONCLUSION: In Indian population, senile valvular degeneration is the commonest cause of acquired IAS with majority of them presenting before 60 years of age, thereby bereaving them with the option of TAVR as a treatment modality.