Screening for unrecognised heart valve disease

Valvular heart disease can affect any one of the heart’s four valves but it most commonly affects the two valves called the aortic valve and the mitral valve. It can cause one of two things on the whole. It can cause either leaking of the valve or it can cause narrowing of the valve. Both of these things make the heart work harder and make it less efficient. Over time that extra work for the heart can effectively tire the heart out and like any muscle which is working too hard over a long period of time it begins to work less efficiently and it begins to fail. So what we aim to do with the treatment of valve disease is to intervene before the heart muscle becomes too tired out and before that element of heart failure has occurred.

So this is an important area because valve disease is relatively less well understood compared with other areas of heart disease and we don’t know how common it is or the time period in which it is going to progress. The difficulty with valve disease is that unlike many other diseases it may have existed for some time before patients get symptoms. What is important to make sure is that any treatment that we do for the valve disease occurs before there is damage to the heart that can’t be reversed with treatment such as surgery. The difficulty being that symptoms may occur after that irreversible damage has occurred. So what we would hope to be able to look at is whether we can identify more closely when people will need treatment before there is irreversible damage and make sure that treatment occurs at that time, rather than after the damage has been done.

We are trying to find out how common this valve disease is, exactly what types of valve disease we are looking at, what is most common and what is going to be most important in terms of requiring treatment, and also over what time period it might be that people need treatment. So we are aiming to capture the number of people with valve disease but also looking at being able to find out whether people are happy to be examined for valve disease in terms of screening, whether it upsets people or whether actually they are quite comfortable with it and feel that it is worthwhile attending for, and also developing groups of people with valve disease that we can study in more detail over time. 

The majority of valve disease that we are seeing is very mild disease which clinically doesn’t require any further monitoring or follow-up except we may contact them as part of the study in the future. For those people where clearly there is more to be done, or it may be that they’ve got slightly more severe valve disease, then we would recommend to the patients and to their GP that they should be followed up in clinic. Again it depends what type of valve disease it is that they have but in line with current guidelines on the management of valve disease. But for a lot of people with mild valve disease they would only need to come to that second visit.