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Journal ArticleDOI: 10.1136/HEARTJNL-2020-318482

Community prevalence, mechanisms and outcome of mitral or tricuspid regurgitation.

04 Mar 2021-Heart (BMJ)-Vol. 107, Iss: 12, pp 1003-1009
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.

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Topics: valvular heart disease (53%)
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Journal ArticleDOI: 10.1136/HEARTJNL-2021-319094
Claire Bouleti1, Bernard Iung2Institutions (2)
19 Mar 2021-Heart
Abstract: In this issue of Heart , Cahill et al report an analysis of the OxValve cohort assessing the prevalence, presentation and outcome of atrioventricular valve regurgitations.1 The strength of the OxValve cohort is that it was prospectively designed to specifically study heart valve disease using systematic echocardiographic examination in an unselected population aged 65 years or more in a community setting. Echocardiography is the only means to reliably assess the prevalence of heart valve disease since auscultation correctly identifies only around 10% of patients with heart valve disease.2 Unbiased assessment of the prevalence and characteristics of patients with heart valve disease needs to be performed in a community setting, as illustrated by differences between the OxValve and the hospital database cohorts. Moreover, contemporary guideline-based criteria were used in the OxValve cohort for the quantification of the severity of regurgitations and the identification of their mechanisms. Such detailed analyses were not performed in the rare previous population-based studies on the epidemiology of heart valve disease. The collection of detailed and standardised echocardiographic data in a large population-based study is therefore highly relevant in the field of heart valve disease. The unadjusted prevalence of moderate or severe mitral or tricuspid regurgitation was estimated at 2.0% in subjects aged 65–75 years and 7.7% in those aged ≥75 years. This considerable increase in the prevalence …

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Topics: Heart valve (60%), Atrioventricular valve (59%), Tricuspid Valve Insufficiency (53%) ... show more

1 Citations


Open accessJournal ArticleDOI: 10.3390/JCDD8090107
Abstract: Even though the tricuspid valve is no longer "forgotten", it still remains poorly understood. In this review, we focus on some controversial and still unclear aspects of tricuspid anatomy as illustrated by noninvasive imaging techniques. In particular, we discuss the anatomical architecture of the so-called tricuspid annulus with its two components (i.e., the mural and the septal annulus), emphasizing the absence of any fibrous "ring" around the right atrioventricular junction. Then we discussed the extreme variability in number and size of leaflets (from two to six), highlighting the peculiarities of the septal leaflet as part of the septal atrioventricular junction (crux cordis). Finally, we describe the similarities and differences between the tricuspid and mitral valve, suggesting a novel terminology for tricuspid leaflets.

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Topics: Tricuspid Valve Insufficiency (70%), Tricuspid valve (68%), Mitral valve (59%) ... show more

1 Citations


Journal ArticleDOI: 10.1007/S11936-021-00938-X
Srikanth Yandrapalli1, Dhaval Kolte2Institutions (2)
Abstract: Clinically significant tricuspid regurgitation (TR) is increasingly prevalent in the aging population. TR is a progressive disease associated with worse outcomes, and therefore should be treated appropriately and in a timely manner. This review will summarize the indications for treatment of TR, and the invasive modalities currently available or under development for the management of TR. Despite its association with increased morbidity and mortality, surgery for isolated TR is uncommon due to increased operative risk. Various transcatheter tricuspid valve (TV) therapies have been developed as an alternative to surgery to address this unmet clinical need. Transcatheter TV repair devices improve leaflet coaptation either directly by bringing the leaflets together (coaptation devices) or indirectly by repairing the dilated tricuspid annulus (annuloplasty devices), whereas orthotopic transcatheter TV replacement involves implantation of a prosthesis in the tricuspid position. Recent first-in-man and phase 1/2 clinical investigations have demonstrated high procedural success rates with reasonable safety and efficacy. Transcatheter TV therapies may offer a less invasive and potentially safer alternative to surgery for the management of severe symptomatic TR. Ongoing studies will shed light on long-term outcomes and device durability, and inform patient selection and optimal timing of intervention.

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Topics: Tricuspid valve (58%)

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16 results found


Journal ArticleDOI: 10.1016/S0140-6736(06)69208-8
16 Sep 2006-The Lancet
Abstract: Summary Background Valvular heart diseases are not usually regarded as a major public-health problem. Our aim was to assess their prevalence and effect on overall survival in the general population. Methods We pooled population-based studies to obtain data for 11 911 randomly selected adults from the general population who had been assessed prospectively with echocardiography. We also analysed data from a community study of 16 501 adults who had been assessed by clinically indicated echocardiography. Findings In the general population group, moderate or severe valve disease was identified in 615 adults. There was no difference in the frequency of such diseases between men and women (p=0·90). Prevalence increased with age, from 0·7% (95% CI 0·5–1·0) in 18–44 year olds to 13·3% (11·7–15·0) in the 75 years and older group (p Interpretation Moderate or severe valvular diseases are notably common in this population and increase with age. In the community, women are less often diagnosed than are men, which could indicate an important imbalance in view of the associated lower survival. Valve diseases thus represent an important public-health problem.

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Topics: Population (59%)

2,948 Citations


Open accessJournal ArticleDOI: 10.1016/S0195-668X(03)00201-X
Abstract: To identify the characteristics, treatment, and outcomes of contemporary patients with valvular heart disease (VHD) in Europe, and to examine adherence to guidelines.

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Topics: valvular heart disease (69%), Cardiac surgery (56%)

2,895 Citations


Journal ArticleDOI: 10.1093/EJECHOCARD/JEQ031
Abstract: Mitral and tricuspid are increasingly prevalent. Doppler echocardiography not only detects the presence of regurgitation but also permits to understand mechanisms of regurgitation, quantification of its severity and repercussions. The present document aims to provide standards for the assessment of mitral and tricuspid regurgitation.

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Topics: Tricuspid valve (66%), Mitral valve (64%), Tricuspid Valve Insufficiency (61%) ... show more

1,282 Citations


Open accessJournal ArticleDOI: 10.1016/J.JACC.2003.09.036
Abstract: Objectives The goal of this study was to examine mortality associated with tricuspid regurgitation (TR) after controlling for left ventricular ejection fraction (LVEF), right ventricular (RV) dilation and dysfunction, and pulmonary artery systolic pressure (PASP). Background Tricuspid regurgitation is a frequent echocardiographic finding; however, the association with prognosis is unclear. Methods We retrospectively identified 5,223 patients (age 66.5 ± 12.8 years; predominantly male) undergoing echocardiography at one of three Veterans Affairs Medical Center laboratories over a period of four years. Follow-up data were available for four years (mean 498 ± 402 days). Kaplan-Meier and proportional hazards methods were used to compare differences in survival among TR grades. Results Mortality increased with increasing severity of TR. The one-year survival was 91.7% with no TR, 90.3% with mild TR, 78.9% with moderate TR, and 63.9% with severe TR. Moderate or greater TR was associated with increased mortality regardless of PASP (hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.16 to 1.49 for PASP >40 mm Hg; HR 1.32, 95% CI 1.05 to 1.62 for PASP ≤40 mm Hg) and LVEF (HR 1.49, 95% CI 1.34 to 1.66 for EF Conclusions We conclude that increasing TR severity is associated with worse survival in men regardless of LVEF or pulmonary artery pressure. Severe TR is associated with a poor prognosis, independent of age, biventricular systolic function, RV size, and dilation of the inferior vena cava.

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Topics: Inferior vena cava (54%), Tricuspid valve (52%)

1,036 Citations


Journal ArticleDOI: 10.1056/NEJMOA041451
Abstract: background The clinical outcome of asymptomatic mitral regurgitation is poorly defined, and the treatment is uncertain. We studied the effect on the outcome of quantifying mitral regurgitation according to recent guidelines. methods We prospectively enrolled 456 patients (mean [±SD] age, 63±14 years; 63 percent men; ejection fraction, 70±8 percent) with asymptomatic organic mitral regurgitation, quantified according to current recommendations (regurgitant volume, 66±40 ml per beat; effective regurgitant orifice, 40±27 mm 2 ). results The estimated five-year rates (±SE) of death from any cause, death from cardiac causes, and cardiac events (death from cardiac causes, heart failure, or new atrial fibrillation) with medical management were 22±3 percent, 14±3 percent, and 33±3 percent, respectively. Independent determinants of survival were increasing age, the presence of diabetes, and increasing effective regurgitant orifice (adjusted risk ratio per 10-mm 2 increment, 1.18; 95 percent confidence interval, 1.06 to 1.30; P<0.01), the predictive power of which superseded all other qualitative and quantitative measures of regurgitation. Patients with an effective regurgitant orifice of at least 40 mm 2 had a five-year survival rate that was lower than expected on the basis of U.S. Census data (58±9 percent vs. 78 percent, P=0.03). As compared with patients with a regurgitant orifice of less than 20 mm 2 , those with an orifice of at least 40 mm 2 had an increased risk of death from any cause (adjusted risk ratio, 2.90; 95 percent confidence interval, 1.33 to 6.32; P<0.01), death from cardiac causes (adjusted risk ratio, 5.21; 95 percent confidence interval, 1.98 to 14.40; P<0.01), and cardiac events (adjusted risk ratio, 5.66; 95 percent confidence interval, 3.07 to 10.56; P<0.01). Cardiac surgery was ultimately performed in 232 patients and was independently associated with improved survival (adjusted risk ratio, 0.28; 95 percent confidence interval, 0.14 to 0.55; P<0.01). conclusions Quantitative grading of mitral regurgitation is a powerful predictor of the clinical outcome of asymptomatic mitral regurgitation. Patients with an effective regurgitant orifice of at least 40 mm 2 should promptly be considered for cardiac surgery.

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Topics: Effective Regurgitant Orifice Area (62%), Mitral regurgitation (57%), Confidence interval (52%) ... show more

943 Citations