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
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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.
Patient consent for publication Not required.
Ethics approval The study was approved by the UK Research Ethics Committee (ref: 09/H0502/58) and all participants provided written informed consent.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request to firstname.lastname@example.org.
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