title: Demographics of severe valvular aortic stenosis in Singapore.
abstract: BACKGROUND
  The treatment of aortic valve stenosis (AS) is seeing renewed interest mainly due to the availability of transcatheter therapies. However, the number of epidemiological studies of this disease in Singapore is limited. We aimed to describe the aetiology and clinical presentation of AS in Singapore, as well as patients' attitudes toward it. Our findings may facilitate the future planning and utilisation of resources to better manage these patients.
  
  
  METHODS
  249 consecutive patients who underwent transthoracic echocardiography (from April 1999 to April 2008) and diagnosed with severe AS were assessed. Demographic and clinical data were collected, and patients' decisions on surgery were determined.
  
  
  RESULTS
  The mean patient age was 71 (range 23-98) years. 50.2% of patients were male. The commonest presenting symptom was dyspnoea, and 40 (16.0%) patients had coexistent atrial fibrillation. The aetiology of AS was degenerative in 216 (86.7%), rheumatic in 11 (4.4%) and related to a bicuspid valve in 22 (8.9%) patients. The average peak velocity across the aortic valve was 4.2 ± 0.8 m/s and the mean aortic valve area was 0.76 ± 0.13 cm2. The overall mean logistic EuroSCORE was 10.7 ± 12.3. 105 (42.2%) patients who were offered surgery refused. 87 (35%) deaths were seen during the follow-up period (mean duration 14.5 months), which also saw 68 (27%) patients undergo surgery and 86 (34%) patients hospitalised for heart failure.
  
  
  CONCLUSIONS
  Degenerative AS was the commonest aetiology in this contemporary cohort of patients. Despite the known benefits of surgery, the refusal rate for surgery remained high.
authors: National University Heart Centre, Centre, National University Health System, Singapore. Edgar_Tay@nuhs.edu.sg
authors: Edgar L W
authors: EL
authors: Tay
authors: Pei Shi
authors: PS
authors: Lew
authors: Kian Keong
authors: KK
authors: Poh
authors: Rafael
authors: R
authors: Saclolo
authors: Boon-Lock
authors: BL
authors: Chia
authors: Tiong Cheng
authors: TC
authors: Yeo
authors: Huay Cheem
authors: HC
authors: Tan
authors: James W L
authors: JW
authors: Yip
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology*; D044466:Asian People; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis; D015331:Cohort Studies; D004417:Dyspnea / Q000150:complications / Q000175:diagnosis; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012846:Singapore