title: A hospital-based survey of patients with severe valvular heart disease in China.
abstract: OBJECTIVE
  Due to increasing aging, the epidemiology of VHD may have changed in China. This study aimed to provide contemporary information on the prevalence, distribution patterns, and etiology of severe VHD in China.
  
  
  METHODS
  This was a retrospective survey at Second Affiliated Hospital of Zhejiang University, which included all consecutive patients between 2010 and 2015.
  
  
  RESULTS
  In all, 139,496 patients were enrolled. Among severe valve diseases, MR was the most frequent (n=946, 0.68%) followed by MS (n=524, 0.38%), AS (n=392, 0.28%), and AR (n=371, 0.27%). Severe MR and AS prevalence rates increased strikingly with age. Rheumatic heart disease had an prevalence of 1.56% (n=2179), and remained one of the most common causes of severe VHD in patients younger than 65years old (99.5% of MS with rheumatic; 27.6% of MR with rheumatic; 25.7% of AS with rheumatic; 31.6% of AR with rheumatic). Aortic valve calcification was the predominant AS etiology, and its prevalence greatly increased with age. In severe AR, rheumatic fever was the most common etiology in patients below 65; in those above 65, etiology was mostly degenerative. In severe primary MR, mitral valve prolapse was the most common cause. Prevalence of secondary MR increased with age, from 16.4% in 18-44years old to 51.7% in individuals ≥75.
  
  
  CONCLUSIONS
  Severe valvular diseases are very common; rheumatic fever and degenerative valvular changes remain predominant causes in patients below 65 and older ones, respectively. Young adults present mainly with primary MR, while secondary MR is more common in elderly ones.
authors.affiliation: Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China.
authors.forename: Po
authors.initials: P
authors.lastname: Hu
authors.affiliation: Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China.
authors.forename: Xian-Bao
authors.initials: XB
authors.lastname: Liu
authors.affiliation: Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Liang
authors.affiliation: Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China.
authors.forename: Qi-Feng
authors.initials: QF
authors.lastname: Zhu
authors.affiliation: Department of Echocardiography, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China.
authors.forename: Chao-Xia
authors.initials: CX
authors.lastname: Pu
authors.affiliation: Harvard T.H. Chan School of Public Health. United States.
authors.forename: Meng-Yao
authors.initials: MY
authors.lastname: Tang
authors.affiliation: Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China. Electronic address: jian_an_wang@yahoo.com.
authors.forename: Jian-An
authors.initials: JA
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006306:Health Surveys; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000453:epidemiology*; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
keywords: China; Epidemiology; Severe; Valvular heart disease