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Valvular heart disease
Original research
Community prevalence, mechanisms and outcome of mitral or tricuspid regurgitation
  1. Thomas J Cahill1,
  2. Anthony Prothero2,
  3. Jo Wilson2,3,
  4. Andrew Kennedy2,
  5. Jacob Brubert2,
  6. Megan Masters2,
  7. James D Newton2,
  8. Sam Dawkins2,
  9. Maurice Enriquez-Sarano4,
  10. Bernard D Prendergast5,
  11. Saul G Myerson1,2
  1. 1 Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
  2. 2 Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
  3. 3 British Association of Nursing for Cardiac Care, Oxford, UK
  4. 4 Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
  5. 5 St Thomas’ Hospital, London, UK
  1. Correspondence to Prof Saul G Myerson, OCMR Department, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK; saul.myerson{at}cardiov.ox.ac.uk

Abstract

Objective The study aims were (1) to identify the community prevalence of moderate or greater mitral or tricuspid regurgitation (MR/TR), (2) to compare subjects identified by population screening with those with known valvular heart disease (VHD), (3) to understand the mechanisms of MR/TR and (4) to assess the rate of valve intervention and long-term outcome.

Methods Adults aged ≥65 years registered at seven family medicine practices in Oxfordshire, UK were screened for inclusion (n=9504). Subjects with known VHD were identified from hospital records and those without VHD invited to undergo transthoracic echocardiography (TTE) within the Oxford Valvular Heart Disease Population Study (OxVALVE). The study population ultimately comprised 4755 subjects. The severity and aetiology of MR and TR were assessed by integrated comprehensive TTE assessment.

Results The prevalence of moderate or greater MR and TR was 3.5% (95% CI 3.1 to 3.8) and 2.6% (95% CI 2.3 to 2.9), respectively. Primary MR was the most common aetiology (124/203, 61.1%). Almost half of cases were newly diagnosed by screening: MR 98/203 (48.3%), TR 69/155 (44.5%). Subjects diagnosed by screening were less symptomatic, more likely to have primary MR and had a lower incidence of aortic valve disease. Surgical intervention was undertaken in six subjects (2.4%) over a median follow-up of 64 months. Five-year survival was 79.8% in subjects with isolated MR, 84.8% in those with isolated TR, and 59.4% in those with combined MR and TR (p=0.0005).

Conclusions Moderate or greater MR/TR is common, age-dependent and is underdiagnosed. Current rates of valve intervention are extremely low.

  • mitral valve insufficiency
  • tricuspid valve insufficiency
  • heart valve diseases
  • epidemiology

Data availability statement

Data are available on reasonable request to saul.myerson@cardiov.ox.ac.uk.

https://doi.org/10.1136/heartjnl-2020-318482

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    Data availability statement

    Data are available on reasonable request to saul.myerson@cardiov.ox.ac.uk.

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    Footnotes

    • Twitter @tomjcahill, @jbrubert, @sarano_maurice, @saulmyerson

    • Contributors BDP and SGM conceived and designed the study. TJC, AP, JW, AK, JB, MM, JDN and SD performed data extraction and analysis. AP performed and analysed the majority of the community echocardiograms and re-analysed all hospital echocardiograms in the pre-existing VHD group. TJC, BDP and SGM wrote the first draft of the manuscript and all authors reviewed, interpreted and commented on the final version. All authors agree with the results and conclusions of the manuscript and meet the ICMJE criteria for authorship.

    • Funding The OxVALVE study is funded by the UK National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. This study was supported by an unrestricted research grant from Edwards Lifesciences.

    • Competing interests BDP has received unrestricted education and research grants from Edwards Lifesciences and speaker fees from Edwards Lifesciences.

    • Patient and public involvement statement Patients were involved in the design and conduct of the study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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