BACKGROUND
- Valvular heart disease (VHD) is progressive and deadly, requiring timely diagnosis for optimal outcomes1
- Prior landmark analyses of VHD prevalence in the United States (US), including the Framingham Heart Study2 and Nkomo et al.3 , have reported notable prevalence of disease
- However, these analyses were limited in scope (e.g., reporting only valvular regurgitation or only aortic and mitral disease, respectively) and sample sizes
- Contemporary prevalence data from larger datasets are needed to better understand the magnitude of the clinical challenge posed by VHD
OBJECTIVE
- To describe the contemporary prevalence of VHD, as well as key trends in prevalence, in a large deidentified dataset with echocardiographic data
METHODS
- Data source: deidentified echocardiographic dataset developed from the CardioCare platform (egnite Database, egnite, Inc., Aliso Viejo, CA, USA) per participating institutional agreements
- Exemption from Institutional Review Board (IRB) review was obtained for this study from the Western IRB Copernicus Group (Puyallup, WA, US)
- Inclusion criteria:
- Echocardiographic reports with data on age and sex
- Presence of ≥1 valid measurement for aortic valve area, jet velocity, mean pressure gradient, and/or other valve findings
- Echocardiographic procedure dated January 2016 September 2021
- For a given patient, maximum documented severity per VHD type used for analysis
- Exclusion criteria:
- Noted prosthetic devices in report(s)
- Occurrence/severity of VHD determined using a clinically reviewed and verified natural language processing algorithm (100% accuracy demonstrated on a sample of 3,000 echocardiographic reports)
- Disease severity classifications of interest for this analysis: moderate, moderate to severe, severe (i.e., moderate or greater in severity)
- Mixed VHD defined as the presence of any two of the five VHD types measured
RESULTS
- In total, 714,368 patients (represented by 929,386 echocardiographic reports) included across 35 US community and academic cardiology programs
- Median recorded age was 67 years, and approximately half of patient population was female
- Observed prevalence of VHD (moderate or greater in severity) was greatest for tricuspid regurgitation (TR , 7.1%), followed by mitral regurgitation (MR, 6.5%), aortic stenosis (AS, 4.1%), aortic regurgitation (AR, 2.3%), and mitral stenosis (MS, 0.5%)
- The prevalence of all VHD types increased with advancing age, with a marked increase beyond 65 years of age
- Mixed VHD prevalence increased with advancing age, with MR/TR most common across all age categories
- VHD overall (of moderate or greater severity) was more common among female patients versus male patients (p < 0.0001)
- Increases in prevalence of all VHD types (except MS) in both sexes were noted with advancing age
DISCUSSION
- The present study is, to our knowledge, the largest contemporary analysis of VHD prevalence in the US
- Prevalence of VHD continues to be substantial and is more common with advancing age and among female patients
- Prevalence of mixed VHD, particularly MR/TR, also increases with advancing age, which raises concerns around unrecognized and untreated disease in such patients
References
1. Maganti K, et al. Mayo Clin Proc. 2010;85(5):483 50 0.
2. Singh JP, et al. Am J Cardiol 1999;83(6):897 902.
3. Nkomo VT, et al. Lancet. 2006;368(9540):1005 1011.
Brennan JM, Petrescu M, McCarthy P, Moualla S, Nance H, Barnhart GR, Rodriguez E, Thomas J. Contemporary prevalence of valvular heart disease & diagnostic variability across centers. Poster presented at: American College of Cardiology 71st Annual Scientific Session & Expo; April 2–4, 2022; Washington, DC.
