Pulmonic regurgitation epidemiology and demographics: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Pulmonic regurgitation}} | {{Pulmonic regurgitation}} | ||
{{CMG}}{{AE}}{{AKI}}, {{AA}} | {{CMG}}{{AE}}{{AKI}}, {{AA}}, {{JA}} | ||
==Overview== | ==Overview== | ||
The [[prevalence]] of mild [[ | The [[prevalence]] of mild [[PR]] among [[patients]] with normal [[anatomy]] of the [[pulmonary valve]] is 40% to 78%. Among [[patients]] born with [[congenital heart disease]], 20% of [[patients]] have associated abnormalities of the [[pulmonary valve]] or the [[Right ventricular outflow tract obstruction|right ventricular outlet obstruction]]. The [[incidence]] and [[prevalence]] of [[PR]] increases with age. 24% of the [[deaths]] due to [[valvular heart disease]] are attributed to [[tricuspid valve]] and [[pulmonic valve]] abnormalities combined. There is one study supporting the increased [[prevalence]] of [[PR]] among women. In developing countries [[PAH|Pulmonary hypertension]] (PAH) is primarily due to [[rheumatic heart disease]] (RHD) which is rare in developed countries. [[PAH]] is a major cause of secondary [[PR]]. | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
===Prevalence=== | ===Prevalence=== | ||
*The [[prevalence]] of [[valvular heart disease]] in U.S. population is estimated to be 2.5%. About 13% of U.S [[population]] born before 1943 have [[valvular heart disease]].<ref name="urlValvular Heart Disease | cdc.gov">{{cite web |url=https://www.cdc.gov/heartdisease/valvular_disease.htm |title=Valvular Heart Disease | cdc.gov |format= |work= |accessdate=}}</ref> | *The [[prevalence]] of [[valvular heart disease]] in U.S. population is estimated to be 2.5%. About 13% of U.S [[population]] born before 1943 have [[valvular heart disease]].<ref name="urlValvular Heart Disease | cdc.gov">{{cite web |url=https://www.cdc.gov/heartdisease/valvular_disease.htm |title=Valvular Heart Disease | cdc.gov |format= |work= |accessdate=}}</ref> | ||
*The [[prevalence]] of mild [[PR]] | *The [[prevalence]] of mild [[PR]] among [[patients]] with normal [[anatomy]] of the [[pulmonary valve]] is 40% to 78%.<ref name="pmid2784023">{{cite journal| author=Choong CY, Abascal VM, Weyman J, Levine RA, Gentile F, Thomas JD et al.| title=Prevalence of valvular regurgitation by Doppler echocardiography in patients with structurally normal hearts by two-dimensional echocardiography. | journal=Am Heart J | year= 1989 | volume= 117 | issue= 3 | pages= 636-42 | pmid=2784023 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2784023 }} </ref><ref name="ZoghbiAdams2017">{{cite journal|last1=Zoghbi|first1=William A.|last2=Adams|first2=David|last3=Bonow|first3=Robert O.|last4=Enriquez-Sarano|first4=Maurice|last5=Foster|first5=Elyse|last6=Grayburn|first6=Paul A.|last7=Hahn|first7=Rebecca T.|last8=Han|first8=Yuchi|last9=Hung|first9=Judy|last10=Lang|first10=Roberto M.|last11=Little|first11=Stephen H.|last12=Shah|first12=Dipan J.|last13=Shernan|first13=Stanton|last14=Thavendiranathan|first14=Paaladinesh|last15=Thomas|first15=James D.|last16=Weissman|first16=Neil J.|title=Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation|journal=Journal of the American Society of Echocardiography|volume=30|issue=4|year=2017|pages=303–371|issn=08947317|doi=10.1016/j.echo.2017.01.007}}</ref><ref name="pmid3382565">{{cite journal| author=Takao S, Miyatake K, Izumi S, Okamoto M, Kinoshita N, Nakagawa H et al.| title=Clinical implications of pulmonary regurgitation in healthy individuals: detection by cross sectional pulsed Doppler echocardiography. | journal=Br Heart J | year= 1988 | volume= 59 | issue= 5 | pages= 542-50 | pmid=3382565 | doi= | pmc=1276894 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3382565 }} </ref><ref name="pmid2310593">{{cite journal| author=Klein AL, Burstow DJ, Tajik AJ, Zachariah PK, Taliercio CP, Taylor CL et al.| title=Age-related prevalence of valvular regurgitation in normal subjects: a comprehensive color flow examination of 118 volunteers. | journal=J Am Soc Echocardiogr | year= 1990 | volume= 3 | issue= 1 | pages= 54-63 | pmid=2310593 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2310593 }} </ref> | ||
*In 1987, the [[prevalence]] of [[PR]] | *In 1987, the [[prevalence]] of [[PR]] among [[patients]] with structurally normal [[heart|hearts]] was estimated to be 5% in Boston area [[population]], USA.<ref name="pmid2784023">{{cite journal| author=Choong CY, Abascal VM, Weyman J, Levine RA, Gentile F, Thomas JD et al.| title=Prevalence of valvular regurgitation by Doppler echocardiography in patients with structurally normal hearts by two-dimensional echocardiography. | journal=Am Heart J | year= 1989 | volume= 117 | issue= 3 | pages= 636-42 | pmid=2784023 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2784023 }} </ref> | ||
*In 1990, the [[prevalence]] of [[PR]] | *In 1990, the [[prevalence]] of [[PR]] among normal [[patients]] (21 - 82 years) was estimated to be 31%.<ref name="pmid2310593">{{cite journal| author=Klein AL, Burstow DJ, Tajik AJ, Zachariah PK, Taliercio CP, Taylor CL et al.| title=Age-related prevalence of valvular regurgitation in normal subjects: a comprehensive color flow examination of 118 volunteers. | journal=J Am Soc Echocardiogr | year= 1990 | volume= 3 | issue= 1 | pages= 54-63 | pmid=2310593 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2310593 }} </ref> | ||
*In 1992, the [[prevalence]] of [[PR]] | *In 1992, the [[prevalence]] of [[PR]] among children (birth- 14 years) with structurally normal [[heart|hearts]] was estimated to be 21.9% in Jerusalem, Israel [[population]]. [[Pulmonic regurgitation]] was the most common of all valvular [[regurgitations]] detected among children.<ref name="BrandDollberg1992">{{cite journal|last1=Brand|first1=Abraham|last2=Dollberg|first2=Shaul|last3=Keren|first3=Andre|title=The prevalence of valvular regurgitation in children with structurally normal hearts: A color Doppler echocardiographic study|journal=American Heart Journal|volume=123|issue=1|year=1992|pages=177–180|issn=00028703|doi=10.1016/0002-8703(92)90763-L}}</ref> | ||
*In 1993, the prevalence of [[rheumatic fever]] in the developing countries was estimated to be 18.6/1000.<ref name="pmid8432279">{{cite journal |vauthors=Eisenberg MJ |title=Rheumatic heart disease in the developing world: prevalence, prevention, and control |journal=Eur. Heart J. |volume=14 |issue=1 |pages=122–8 |date=January 1993 |pmid=8432279 |doi=10.1093/eurheartj/14.1.122 |url=}}</ref> [[Rheumatic fever]] is still a significant cause of [[PR]] in developing countries. | |||
*There is a 50% chance of [[heart|cardiac]] involvement in [[carcinoid syndrome]].<ref name="pmid15367531">{{cite journal |vauthors=Fox DJ, Khattar RS |title=Carcinoid heart disease: presentation, diagnosis, and management |journal=Heart |volume=90 |issue=10 |pages=1224–8 |date=October 2004 |pmid=15367531 |pmc=1768473 |doi=10.1136/hrt.2004.040329 |url=}}</ref> A large US case series on [[carcinoid syndrome]] reported that 81% of individuals demonstrated [[PR]]. <ref name="pmid7681733">{{cite journal |vauthors=Pellikka PA, Tajik AJ, Khandheria BK, Seward JB, Callahan JA, Pitot HC, Kvols LK |title=Carcinoid heart disease. Clinical and echocardiographic spectrum in 74 patients |journal=Circulation |volume=87 |issue=4 |pages=1188–96 |date=April 1993 |pmid=7681733 |doi=10.1161/01.cir.87.4.1188 |url=}}</ref> | |||
===Incidence=== | ===Incidence=== | ||
* | *Among [[patients]] born with [[congenital heart disease]], 20% of [[patients]] have associated abnormalities of the [[pulmonary valve]] or the [[Right ventricular outflow tract obstruction|right ventricular outlet obstruction]].<ref name="pmid2784023">{{cite journal| author=Choong CY, Abascal VM, Weyman J, Levine RA, Gentile F, Thomas JD et al.| title=Prevalence of valvular regurgitation by Doppler echocardiography in patients with structurally normal hearts by two-dimensional echocardiography. | journal=Am Heart J | year= 1989 | volume= 117 | issue= 3 | pages= 636-42 | pmid=2784023 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2784023 }} </ref> | ||
*[[Rheumatic heart disease]] (RHD), a rare cause of [[PR]] in developed countries but developing world still shares the burden of the [[disease]]. | |||
**In 1989, the incidence rate of [[rheumatic fever]] in developing countries was estimated to be 100 per 100,000 young individuals.<ref name="urlapps.who.int">{{cite web |url=https://apps.who.int/iris/bitstream/handle/10665/46841/WHF_1989_10(2)_p203-212.pdf |title=apps.who.int |format= |work= |accessdate=}}</ref> | |||
**In 1993, the incidence rate of [[rheumatic fever]] in the developing countries was estimated to be 206/100,000.<ref name="pmid8432279">{{cite journal |vauthors=Eisenberg MJ |title=Rheumatic heart disease in the developing world: prevalence, prevention, and control |journal=Eur. Heart J. |volume=14 |issue=1 |pages=122–8 |date=January 1993 |pmid=8432279 |doi=10.1093/eurheartj/14.1.122 |url=}}</ref> | |||
**In 2013, 120 deaths were attributed to [[RHD]] in a referral cardiac center of northern India (Patna).<ref name="prasadKumar2017">{{cite journal|last1=prasad|first1=Arun|last2=Kumar|first2=Sanjeev |last3=Kr Singh|first3= Birendra |last4=Kumari|first4=Neelam |title=Mortality Due to Rheumatic Heart Disease in Developing World: A Preventable Problem|journal=Journal of Clinical & Experimental Cardiology|volume=08|issue=03|year=2017|issn=21559880|doi=10.4172/2155-9880.1000503}}</ref> | |||
*Among [[patients]] with mechanical [[heart valves]], the [[incidence]] of major [[thromboembolic]] events has been estimated to be approximately: | |||
**In the absence of [[antithrombotic therapy]], 4 per 100 patient-years.<ref name="pmid8313552">{{cite journal |vauthors=Cannegieter SC, Rosendaal FR, Briët E |title=Thromboembolic and bleeding complications in patients with mechanical heart valve prostheses |journal=Circulation |volume=89 |issue=2 |pages=635–41 |date=February 1994 |pmid=8313552 |doi=10.1161/01.cir.89.2.635 |url=}}</ref> | |||
**In the absence of systemic [[anticoagulation]], 23 per 100 patient-years.<ref name="pmid7739245">{{cite journal |vauthors=Baudet EM, Puel V, McBride JT, Grimaud JP, Roques F, Clerc F, Roques X, Laborde N |title=Long-term results of valve replacement with the St. Jude Medical prosthesis |journal=J. Thorac. Cardiovasc. Surg. |volume=109 |issue=5 |pages=858–70 |date=May 1995 |pmid=7739245 |doi=10.1016/S0022-5223(95)70309-8 |url=}}</ref> | |||
===Case-fatality rate/Mortality rate=== | ===Case-fatality rate/Mortality rate=== | ||
| Line 21: | Line 30: | ||
===Age=== | ===Age=== | ||
*[[ | *The prevalence of [[pulmonary regurgitation]] (PR) is estimated to have two demographic peaks. The first peak is among young [[patients]] with repaired congenital [[pulmonary stenosis]]. The second peak is among [[patients]] with [[pulmonary arterial hypertension]] (PAH).<ref>{{cite book | last = Fauci | first = Anthony | title = Harrison's principles of internal medicine | publisher = McGraw-Hill Medical | location = New York | year = 2008 | isbn = 978-0071466332 }}</ref> The multitude of causes makes the determination of exact [[prevalence]] of [[PR]] difficult.<ref name="urlPulmonary valve regurgitation | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/pulmonary-valve-regurgitation |title=Pulmonary valve regurgitation | Radiology Reference Article | Radiopaedia.org |format= |work= |accessdate=}}</ref> | ||
*In the U.S [[population]], the [[prevalence]] of [[valvular heart disease]] is higher | *In the U.S [[population]], the [[prevalence]] of [[valvular heart disease]] is higher among older adults.<ref name="urlValvular Heart Disease | cdc.gov">{{cite web |url=https://www.cdc.gov/heartdisease/valvular_disease.htm |title=Valvular Heart Disease | cdc.gov |format= |work= |accessdate=}}</ref> | ||
* In 1989, a meta‐analysis reported that 29% of the [[patients]] with isolated congenital [[PR]] develop symptoms within 40 years. The risk of development of symptoms demonstrated an increase with age, particularly after 40 years.<ref name="ShimazakiBlackstone2008">{{cite journal|last1=Shimazaki|first1=Y.|last2=Blackstone|first2=E.|last3=Kirklin|first3=J.|title=The Natural History of Isolated Congenital Pulmonary Valve Incompetence: Surgical Implications|journal=The Thoracic and Cardiovascular Surgeon|volume=32|issue=04|year=2008|pages=257–259|issn=0171-6425|doi=10.1055/s-2007-1023399}}</ref> | * In 1989, a meta‐analysis reported that 29% of the [[patients]] with isolated congenital [[PR]] develop symptoms within 40 years. The risk of development of symptoms demonstrated an increase with age, particularly after 40 years.<ref name="ShimazakiBlackstone2008">{{cite journal|last1=Shimazaki|first1=Y.|last2=Blackstone|first2=E.|last3=Kirklin|first3=J.|title=The Natural History of Isolated Congenital Pulmonary Valve Incompetence: Surgical Implications|journal=The Thoracic and Cardiovascular Surgeon|volume=32|issue=04|year=2008|pages=257–259|issn=0171-6425|doi=10.1055/s-2007-1023399}}</ref> | ||
*In 1990, the [[incidence]] of mild degree valvular regurgitation in normal subjects was estimated to increase with [[age]].<ref name="pmid2310593">{{cite journal| author=Klein AL, Burstow DJ, Tajik AJ, Zachariah PK, Taliercio CP, Taylor CL et al.| title=Age-related prevalence of valvular regurgitation in normal subjects: a comprehensive color flow examination of 118 volunteers. | journal=J Am Soc Echocardiogr | year= 1990 | volume= 3 | issue= 1 | pages= 54-63 | pmid=2310593 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2310593 }} </ref> | *In 1990, the [[incidence]] of mild degree valvular [[regurgitation]] in normal subjects was estimated to increase with [[age]].<ref name="pmid2310593">{{cite journal| author=Klein AL, Burstow DJ, Tajik AJ, Zachariah PK, Taliercio CP, Taylor CL et al.| title=Age-related prevalence of valvular regurgitation in normal subjects: a comprehensive color flow examination of 118 volunteers. | journal=J Am Soc Echocardiogr | year= 1990 | volume= 3 | issue= 1 | pages= 54-63 | pmid=2310593 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2310593 }} </ref> | ||
*In 2017, the [[incidence]] of [[PR]] | *In 2017, the [[incidence]] of [[PR]] among Tibetans (one of the highest cities in the world) was speculated to increase with age.<ref name="pmid28937038">{{cite journal |vauthors=Yang Y, Chen YD, Feng B, Ji ZX, Mao W, Zhi G |title=Factors Related to Ventricular Size and Valvular Regurgitation in Healthy Tibetans in Lhasa |journal=Chin. Med. J. |volume=130 |issue=19 |pages=2316–2320 |date=October 2017 |pmid=28937038 |pmc=5634082 |doi=10.4103/0366-6999.215327 |url=}}</ref> | ||
*[[Carcinoid syndrome history and symptoms|Carcinoid symptoms]] typically appear at a mean [[age]] of 55–60 years and usually takes 2 years before symptoms due to [[valvular heart disease|valvular disease]] develop.<ref name="pmid15367531">{{cite journal |vauthors=Fox DJ, Khattar RS |title=Carcinoid heart disease: presentation, diagnosis, and management |journal=Heart |volume=90 |issue=10 |pages=1224–8 |date=October 2004 |pmid=15367531 |pmc=1768473 |doi=10.1136/hrt.2004.040329 |url=}}</ref> | |||
===Race=== | ===Race=== | ||
| Line 31: | Line 43: | ||
===Gender=== | ===Gender=== | ||
*In 2017, [[PR|Pulmonic regurgitation]] (PR) was | *In 2017, [[PR|Pulmonic regurgitation]] (PR) was speculated to be more [[prevalence|prevalent]] among Tibetan women.<ref name="pmid28937038">{{cite journal |vauthors=Yang Y, Chen YD, Feng B, Ji ZX, Mao W, Zhi G |title=Factors Related to Ventricular Size and Valvular Regurgitation in Healthy Tibetans in Lhasa |journal=Chin. Med. J. |volume=130 |issue=19 |pages=2316–2320 |date=October 2017 |pmid=28937038 |pmc=5634082 |doi=10.4103/0366-6999.215327 |url=}}</ref> | ||
===Developed Countries=== | ===Developed Countries=== | ||
* | *Among developed countries such as the United States, [[PAH|Pulmonary hypertension]] (PAH) is primarily due to left [[heart]] disease. Other conditions that cause [[PAH]] include [[sickle cell disease]]; [[pulmonary embolus]], and [[chronic obstructive pulmonary disease]] (COPD).<ref name="urlPulmonary Hypertension | NHLBI, NIH">{{cite web |url=https://www.nhlbi.nih.gov/health-topics/pulmonary-hypertension#:~:text=In%20the%20United%20States%2C%20the,obstructive%20pulmonary%20disease%20(COPD). |title=Pulmonary Hypertension | NHLBI, NIH |format= |work= |accessdate=}}</ref> [[PAH]] is a major cause of secondary [[PR]]. | ||
*[[Rheumatic heart disease]] (RHD) is not a common cause of [[PAH]] or [[PR]] | *[[Rheumatic heart disease]] (RHD) is not a common cause of [[PAH]] or [[PR]] among developed countries. Due to the early detection and development of treatment strategies [[RHD]] is rare among developed countries.<ref name="pmid25076991">{{cite journal |vauthors=Bhagavatula SK, Idrees MM |title=Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Challenges in managing pulmonary hypertension in the developing countries |journal=Ann Thorac Med |volume=9 |issue=Suppl 1 |pages=S127–30 |date=July 2014 |pmid=25076991 |pmc=4114281 |doi=10.4103/1817-1737.134059 |url=}}</ref><ref name="VaideeswarButany2016">{{cite journal|last1=Vaideeswar|first1=P.|last2=Butany|first2=J.|title=Valvular Heart Disease|year=2016|pages=485–528|doi=10.1016/B978-0-12-420219-1.00012-4}}</ref> | ||
===Developing Countries=== | ===Developing Countries=== | ||
* | *Among developing countries [[PAH|Pulmonary hypertension]] (PAH) is primarily due to [[rheumatic heart disease]] (RHD), [[schistosomiasis]], [[congenital heart disease]], [[Hemolytic disease of the newborn|hemolytic diseases]]. [[PAH]] is a major cause of secondary [[PR]]. The burden of [[PAH]] is greater among developing than developed countries.<ref name="pmid25076991">{{cite journal |vauthors=Bhagavatula SK, Idrees MM |title=Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Challenges in managing pulmonary hypertension in the developing countries |journal=Ann Thorac Med |volume=9 |issue=Suppl 1 |pages=S127–30 |date=July 2014 |pmid=25076991 |pmc=4114281 |doi=10.4103/1817-1737.134059 |url=}}</ref><ref name="ButrousGhofrani2008">{{cite journal|last1=Butrous|first1=Ghazwan|last2=Ghofrani|first2=Hossein Ardeschir|last3=Grimminger|first3=Friedrich|title=Pulmonary Vascular Disease in the Developing World|journal=Circulation|volume=118|issue=17|year=2008|pages=1758–1766|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.107.727289}}</ref> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 16:30, 8 August 2020
|
Pulmonic regurgitation Microchapters |
|
Diagnosis |
|---|
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2], Aysha Anwar, M.B.B.S[3], Javaria Anwer M.D.[4]
Overview
The prevalence of mild PR among patients with normal anatomy of the pulmonary valve is 40% to 78%. Among patients born with congenital heart disease, 20% of patients have associated abnormalities of the pulmonary valve or the right ventricular outlet obstruction. The incidence and prevalence of PR increases with age. 24% of the deaths due to valvular heart disease are attributed to tricuspid valve and pulmonic valve abnormalities combined. There is one study supporting the increased prevalence of PR among women. In developing countries Pulmonary hypertension (PAH) is primarily due to rheumatic heart disease (RHD) which is rare in developed countries. PAH is a major cause of secondary PR.
Epidemiology and Demographics
Prevalence
- The prevalence of valvular heart disease in U.S. population is estimated to be 2.5%. About 13% of U.S population born before 1943 have valvular heart disease.[1]
- The prevalence of mild PR among patients with normal anatomy of the pulmonary valve is 40% to 78%.[2][3][4][5]
- In 1987, the prevalence of PR among patients with structurally normal hearts was estimated to be 5% in Boston area population, USA.[2]
- In 1990, the prevalence of PR among normal patients (21 - 82 years) was estimated to be 31%.[5]
- In 1992, the prevalence of PR among children (birth- 14 years) with structurally normal hearts was estimated to be 21.9% in Jerusalem, Israel population. Pulmonic regurgitation was the most common of all valvular regurgitations detected among children.[6]
- In 1993, the prevalence of rheumatic fever in the developing countries was estimated to be 18.6/1000.[7] Rheumatic fever is still a significant cause of PR in developing countries.
- There is a 50% chance of cardiac involvement in carcinoid syndrome.[8] A large US case series on carcinoid syndrome reported that 81% of individuals demonstrated PR. [9]
Incidence
- Among patients born with congenital heart disease, 20% of patients have associated abnormalities of the pulmonary valve or the right ventricular outlet obstruction.[2]
- Rheumatic heart disease (RHD), a rare cause of PR in developed countries but developing world still shares the burden of the disease.
- In 1989, the incidence rate of rheumatic fever in developing countries was estimated to be 100 per 100,000 young individuals.[10]
- In 1993, the incidence rate of rheumatic fever in the developing countries was estimated to be 206/100,000.[7]
- In 2013, 120 deaths were attributed to RHD in a referral cardiac center of northern India (Patna).[11]
- Among patients with mechanical heart valves, the incidence of major thromboembolic events has been estimated to be approximately:
- In the absence of antithrombotic therapy, 4 per 100 patient-years.[12]
- In the absence of systemic anticoagulation, 23 per 100 patient-years.[13]
Case-fatality rate/Mortality rate
- In 2017, CDC reported that 24% of deaths due to valvular heart disease were attributed to tricuspid valve and pulmonic valve abnormalities combined.[1]
Age
- The prevalence of pulmonary regurgitation (PR) is estimated to have two demographic peaks. The first peak is among young patients with repaired congenital pulmonary stenosis. The second peak is among patients with pulmonary arterial hypertension (PAH).[14] The multitude of causes makes the determination of exact prevalence of PR difficult.[15]
- In the U.S population, the prevalence of valvular heart disease is higher among older adults.[1]
- In 1989, a meta‐analysis reported that 29% of the patients with isolated congenital PR develop symptoms within 40 years. The risk of development of symptoms demonstrated an increase with age, particularly after 40 years.[16]
- In 1990, the incidence of mild degree valvular regurgitation in normal subjects was estimated to increase with age.[5]
- In 2017, the incidence of PR among Tibetans (one of the highest cities in the world) was speculated to increase with age.[17]
- Carcinoid symptoms typically appear at a mean age of 55–60 years and usually takes 2 years before symptoms due to valvular disease develop.[8]
Race
- There is no racial or ethnic predilection for pulmonary regurgitation.
Gender
- In 2017, Pulmonic regurgitation (PR) was speculated to be more prevalent among Tibetan women.[17]
Developed Countries
- Among developed countries such as the United States, Pulmonary hypertension (PAH) is primarily due to left heart disease. Other conditions that cause PAH include sickle cell disease; pulmonary embolus, and chronic obstructive pulmonary disease (COPD).[18] PAH is a major cause of secondary PR.
- Rheumatic heart disease (RHD) is not a common cause of PAH or PR among developed countries. Due to the early detection and development of treatment strategies RHD is rare among developed countries.[19][20]
Developing Countries
- Among developing countries Pulmonary hypertension (PAH) is primarily due to rheumatic heart disease (RHD), schistosomiasis, congenital heart disease, hemolytic diseases. PAH is a major cause of secondary PR. The burden of PAH is greater among developing than developed countries.[19][21]
References
- ↑ 1.0 1.1 1.2 "Valvular Heart Disease | cdc.gov".
- ↑ 2.0 2.1 2.2 Choong CY, Abascal VM, Weyman J, Levine RA, Gentile F, Thomas JD; et al. (1989). "Prevalence of valvular regurgitation by Doppler echocardiography in patients with structurally normal hearts by two-dimensional echocardiography". Am Heart J. 117 (3): 636–42. PMID 2784023.
- ↑ Zoghbi, William A.; Adams, David; Bonow, Robert O.; Enriquez-Sarano, Maurice; Foster, Elyse; Grayburn, Paul A.; Hahn, Rebecca T.; Han, Yuchi; Hung, Judy; Lang, Roberto M.; Little, Stephen H.; Shah, Dipan J.; Shernan, Stanton; Thavendiranathan, Paaladinesh; Thomas, James D.; Weissman, Neil J. (2017). "Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation". Journal of the American Society of Echocardiography. 30 (4): 303–371. doi:10.1016/j.echo.2017.01.007. ISSN 0894-7317.
- ↑ Takao S, Miyatake K, Izumi S, Okamoto M, Kinoshita N, Nakagawa H; et al. (1988). "Clinical implications of pulmonary regurgitation in healthy individuals: detection by cross sectional pulsed Doppler echocardiography". Br Heart J. 59 (5): 542–50. PMC 1276894. PMID 3382565.
- ↑ 5.0 5.1 5.2 Klein AL, Burstow DJ, Tajik AJ, Zachariah PK, Taliercio CP, Taylor CL; et al. (1990). "Age-related prevalence of valvular regurgitation in normal subjects: a comprehensive color flow examination of 118 volunteers". J Am Soc Echocardiogr. 3 (1): 54–63. PMID 2310593.
- ↑ Brand, Abraham; Dollberg, Shaul; Keren, Andre (1992). "The prevalence of valvular regurgitation in children with structurally normal hearts: A color Doppler echocardiographic study". American Heart Journal. 123 (1): 177–180. doi:10.1016/0002-8703(92)90763-L. ISSN 0002-8703.
- ↑ 7.0 7.1 Eisenberg MJ (January 1993). "Rheumatic heart disease in the developing world: prevalence, prevention, and control". Eur. Heart J. 14 (1): 122–8. doi:10.1093/eurheartj/14.1.122. PMID 8432279.
- ↑ 8.0 8.1 Fox DJ, Khattar RS (October 2004). "Carcinoid heart disease: presentation, diagnosis, and management". Heart. 90 (10): 1224–8. doi:10.1136/hrt.2004.040329. PMC 1768473. PMID 15367531.
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- ↑ prasad, Arun; Kumar, Sanjeev; Kr Singh, Birendra; Kumari, Neelam (2017). "Mortality Due to Rheumatic Heart Disease in Developing World: A Preventable Problem". Journal of Clinical & Experimental Cardiology. 08 (03). doi:10.4172/2155-9880.1000503. ISSN 2155-9880.
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- ↑ Fauci, Anthony (2008). Harrison's principles of internal medicine. New York: McGraw-Hill Medical. ISBN 978-0071466332.
- ↑ "Pulmonary valve regurgitation | Radiology Reference Article | Radiopaedia.org".
- ↑ Shimazaki, Y.; Blackstone, E.; Kirklin, J. (2008). "The Natural History of Isolated Congenital Pulmonary Valve Incompetence: Surgical Implications". The Thoracic and Cardiovascular Surgeon. 32 (04): 257–259. doi:10.1055/s-2007-1023399. ISSN 0171-6425.
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- ↑ Vaideeswar, P.; Butany, J. (2016). "Valvular Heart Disease": 485–528. doi:10.1016/B978-0-12-420219-1.00012-4.
- ↑ Butrous, Ghazwan; Ghofrani, Hossein Ardeschir; Grimminger, Friedrich (2008). "Pulmonary Vascular Disease in the Developing World". Circulation. 118 (17): 1758–1766. doi:10.1161/CIRCULATIONAHA.107.727289. ISSN 0009-7322.