ReviewEpidemiology of Acquired Valvular Heart Disease
Section snippets
Overall profile
The estimation of the overall prevalence of valvular disease in industrialized countries relies on a population-based study performed in the United States, which included 11,911 subjects who underwent echocardiographic examination.2 The age-adjusted prevalence of moderate or severe valvular disease was estimated at 2.5% (95% confidence interval, 2.2%-2.7%). There was no sex difference. The prevalence of valvular disease increased with age: it was < 2% before the age of 65 years and then
Epidemiology of Valvular Disease in Developing Countries
There are major differences in the epidemiology of valvular heart disease between industrialized and developing countries, mainly related to differences in etiologies. Rheumatic heart disease remains by far the leading cause of valvular disease in developing countries. In a South African centre, rheumatic heart disease still accounted for 72% of valvular disease in 2006-2007.57 Of the 344 patients presenting with rheumatic heart disease, 59% had MR, 37% AR, 30% MS, and 9% AS. Median age at
Clinical Implications
The contemporary epidemiology of valvular heart disease has different effects on patient management.
The first challenge is to detect valvular disease at an early stage before complications occur and worsen the prognosis. The comparison between echocardiographic findings and diagnosis have shown that a number cases of at least moderate valvular disease are not diagnosed.2 This underlines the need for appropriate training in auscultation and for echocardiographic evaluation of patients with
Conclusions
Valvular heart disease remains frequent but is subject to important temporal and spatial epidemiologic heterogeneity and this has important consequences on patient management. The predominance of degenerative etiologies in industrialized countries accounts for a high burden of valvular disease in elderly patients with comorbidities. Because 3 in 4 patients present with AS or MR, the recent development of percutaneous approaches is of particular interest to offer an effective therapy to a
Disclosures
Dr Iung has received consultant fees from Abbott, Boehringer Ingelheim, Valtech, and speaker's fees from Edwards Lifesciences. Dr. Vahanian is a member of the Advisory Board for Medtronic, Abbott, Valtech, and Boehringer Ingelheim, and has received speaker's fees from Edwards Lifesciences and Siemens.
References (70)
- et al.
Burden of valvular heart diseases: a population-based study
Lancet
(2006) - et al.
Valvular heart disease in the community: a European experience
Curr Probl Cardiol
(2007) - et al.
Drug-induced fibrotic valvular heart disease
Lancet
(2009) - et al.
Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample
J Am Coll Cardiol
(1993) - et al.
Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study
J Am Coll Cardiol
(1997) - et al.
The prevalence of bicuspid aortic valve in newborns by echocardiographic screening
Am Heart J
(2005) - et al.
Frequency of bicuspid aortic valve in young male conscripts by echocardiogram
Am J Cardiol
(2005) - et al.
High prevalence of unrecognized chordae tendineae rupture in mitral valve prolapse patients undergoing valve replacement surgery
Can J Cardiol
(2013) - et al.
Clinical significance of calcification of the fibrous skeleton of the heart and aortosclerosis in community dwelling elderly. The Cardiovascular Health Study (CHS)
Am Heart J
(2006) - et al.
Risk, determinants, and outcome implications of progression of mitral regurgitation after diagnosis of mitral valve prolapse in a single community
Am J Cardiol
(2008)
Survival implication of left ventricular end-systolic diameter in mitral regurgitation due to flail leaflets a long-term follow-up multicenter study
J Am Coll Cardiol
High prevalence of clinically silent severe mitral regurgitation in patients with heart failure: role for echocardiography
J Am Soc Echocardiogr
Non-ischemic dilated cardiopathy: prognostic value of functional mitral regurgitation
Int J Cardiol
Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study)
Am J Cardiol
Prevalence and clinical correlates of isolated mitral, isolated aortic regurgitation, and both in adults aged 21 to 35 years (from the CARDIA study)
Am J Cardiol
Doppler echocardiographic assessment of progression of aortic regurgitation
Am J Cardiol
Quantitative echocardiographic determinants of clinical outcome in asymptomatic patients with aortic regurgitation: a prospective study
JACC Cardiovasc Imaging
Two-dimensional and Doppler echocardiographic determinants of the natural history of mitral valve narrowing in patients with rheumatic mitral stenosis: implications for follow-up
J Am Coll Cardiol
Mitral stenosis
Lancet
Medical and surgical outcome of tricuspid regurgitation caused by flail leaflets
J Thorac Cardiovasc Surg
A systematic review of population-based studies of infective endocarditis
Chest
Temporal trends in infective endocarditis in the context of prophylaxis guideline modifications: three successive population-based surveys
J Am Coll Cardiol
Simplification of the prophylaxis of endocarditis: we were right!
Arch Cardiovasc Dis
Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database
J Thorac Cardiovasc Surg
Epidemiology of valvular heart disease in the adult
Nat Rev Cardiol
A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease
Eur Heart J
Cardiac surgery after mediastinal radiation: extent of exposure influences outcome
J Thorac Cardiovasc Surg
Calcific aortic valve disease: not simply a degenerative process: a review and agenda for research from the National Heart and Lung and Blood Institute Aortic Stenosis Working Group. Executive summary: calcific aortic valve disease-2011 update
Circulation
The evolving epidemiology of valvular aortic stenosis. The Tromso study
Heart
The changing course of aortic valve disease in Scotland: temporal trends in hospitalizations and mortality and prognostic importance of aortic stenosis
Eur Heart J
Degenerative calcific aortic stenosis: a natural history
Heart
Heart disease and stroke statistics–2013 update: a report from the American Heart Association
Circulation
Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community
Circulation
Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation
Circulation
The risk of the development of aortic stenosis in patients with “benign” aortic valve thickening
Arch Intern Med
Cited by (254)
Timing Surgical Mitral Valve Repair for Primary Mitral Regurgitation: An Opportunity for Sex-Guided Precision Medicine
2024, Journal of the American College of CardiologyAnalysis of the 2021 European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines for the Management of Valvular Heart Disease
2023, Journal of Cardiothoracic and Vascular AnesthesiaSevere mitral regurgitation in nonagenarians: Impact of symptomatic status, frailty and etiology on management and outcomes
2023, International Journal of CardiologyPredicting Stroke and Mortality in Mitral Regurgitation: A Machine Learning Approach
2023, Current Problems in Cardiology
See page 968 for disclosure information.