Associations of Mild or Trace Valvular Abnormalities With Cardiac Remodeling in Older Adults: The ARIC Study

Background The impact of mild/trace valvular abnormalities on cardiac remodeling is not well understood, despite their association with poor cardiovascular outcomes. Methods Using data from 4684 participants in the ARIC (Atherosclerosis Risk in Communities) Study (2011–2013), aged 66 to 90 years, we examined cross‐sectional associations of mild/trace valvular abnormalities (aortic stenosis, aortic regurgitation, and mitral regurgitation) with cardiac parameters using multivariable linear regression models. Cardiac parameters included cardiac structure (eg, left ventricular mass index), systolic function (eg, ejection fraction), diastolic function, and biomarkers (eg, high‐sensitivity cardiac troponin T). Results The prevalence was 4.3% for mild aortic stenosis, 10.9% for mild/trace aortic regurgitation, and 44.7% for mild/trace mitral regurgitation. Mitral regurgitation showed the most consistent associations with cardiac measures (left ventricular mass index 5.48 g/m 2 [95% CI, 4.38–6.57 g/m 2 ]; ejection fraction –1.92% [95% CI, −2.29% to −1.54%]; high‐sensitivity cardiac troponin T 0.08 log ng/L [95% CI, 0.05–0.12 log ng/L]). Aortic stenosis was associated with impaired ventricular filling (Ratio of early transmitral flow velocity to early diastolic mitral annular velocity (E/e’) lateral ratio 2.00 [95% CI, 1.48–2.53]) and elevated biomarkers (high‐sensitivity cardiac troponin T 0.17 ng/L [95% CI, 0.09–0.25 ng/L]), whereas aortic regurgitation was associated with worsened cardiac structure (left ventricular mass index 3.52 [95% CI, 1.76–5.28] g/m 2 ) and systolic dysfunction (ejection fraction −1.54% [95% CI, −2.14% to −0.94%]). A dose–response relationship was also observed between the number of total abnormalities and all cardiac parameters examined. Conclusions Mild/trace mitral regurgitation was most consistently associated with all cardiac parameters examined. Aortic stenosis was associated with elevated E/e’ lateral ratio and high‐sensitivity cardiac troponin T, whereas aortic regurgitation was associated with worsening in cardiac structure and ejection fraction. Our study supports the possibility of pathophysiological contributions of these mild/trace valvular abnormalities.