Mitral regurgitation epidemiology and demographics
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Varun Kumar, M.B.B.S., Lakshmi Gopalakrishnan, M.B.B.S., Rim Halaby, M.D. [2] Khizer Yaseen, M.B.B.S.[3]
Overview
Mitral regurgitation (MR) is the most common valvular regurgitation abnormality and the most common valvular heart disease in the United States[1], with degenerative mitral regurgitation being the most frequent cause of primary MR in developed countries[2]. The prevalence of MR of a severity equal to or more than mild was reported in The Framingham Heart Study as 19.0% in men and 19.1% in women. The prevalence of MR increases with age.
Prevalence
- The Framingham Heart Study, a prospective epidemiologic study, evaluated the prevalence and severity of MR and other valvular diseases by color Doppler examinations in 1,696 men and 1,893 women.
- Mitral regurgitation (MR) is the most common valvular regurgitation in the general population, followed by tricuspid regurgitation and aortic regurgitation, and constitutes a major proportion of the burden of valvular heart disease in population-based studies[3].
- Degenerative mitral regurgitation is particularly prevalent in developed countries and represents the most common etiology of primary MR in Western populations[2].
- The prevalence of MR (with a severity ranging from trace to ≥ moderate regurgitation) was 87.7% in men and 91.5% in women.
- When trace regurgitation is excluded, the prevalence of MR of a severity ≥ mild was 19.0% in men and 19.1% in women.
- The elevated prevalence of trace regurgitation can be a normal finding related to an artifact or an anatomic characteristic of the closure of the mitral valve.[4][5]
Age
- The prevalence of MR increases with age. MR is one of the most common valvular heart disease in the elderly.
- Shown below are tables depicting the prevalence of MR by age and severity in men and women according the results of the Framingham Heart Study.[4]
- Clinical outcomes in mitral regurgitation are influenced by age, with older age identified as an important determinant of mortality and disease progression[6]
| Severity of MR | Prevalence of MR by age in men | ||||
| 26-29 | 40-49 | 50-59 | 60-69 | 70-83 | |
| No MR (%) | 14.4 | 13.3 | 11.3 | 12.7 | 9.0 |
| Trace (%) | 76.7 | 72.9 | 74.6 | 60.3 | 51.7 |
| Mild (%) | 8.9 | 13.5 | 12.5 | 24.6 | 28.1 |
| Moderate or severe (%) | 0 | 0.3 | 1.6 | 2.4 | 11.2 |
| Severity of MR | Prevalence of MR by age in women | ||||
| 26-29 | 40-49 | 50-59 | 60-69 | 70-83 | |
| No MR (%) | 14.0 | 8.6 | 9.0 | 7.2 | 5.6 |
| Trace (%) | 76.3 | 75 | 74 | 66.5 | 70.8 |
| Mild (%) | 9.7 | 15.5 | 16 | 24 | 23.6 |
| Moderate or severe (%) | 0 | 0.9 | 1 | 2.3 | 0 |
Gender[7]
Sex differences have been observed in the structural remodeling associated with primary mitral regurgitation, with females generally demonstrating smaller left ventricular dimensions for the same degree of regurgitation severity[7][8]. Additionally, women may be referred for surgical intervention less frequently and at later stages of disease compared with men[7].
Prognosis
Without appropriate intervention, severe primary mitral regurgitation carries an adverse prognosis, with more than 90% of untreated patients developing heart failure or death within 10 years[9]
Demographic Factors
Several demographic and clinical factors influence outcomes in primary mitral regurgitation. Older age, reduced left ventricular ejection fraction, increased left ventricular end-systolic dimension, left atrial enlargement, pulmonary hypertension, right ventricular dysfunction, and atrial arrhythmias have been associated with worse clinical outcomes and increased mortality[6].
References
- ↑ Rosenhek R, Rader F, Klaar U, Gabriel H, Krejc M, Kalbeck D, Schemper M, Maurer G, Baumgartner H. Outcome of watchful waiting in asymptomatic severe mitral regurgitation. Circulation. 2006 May 9;113(18):2238-44. doi: 10.1161/CIRCULATIONAHA.105.599175. Epub 2006 May 1. PMID: 16651470.
- ↑ 2.0 2.1 Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet. 2009 Apr 18;373(9672):1382-94. doi: 10.1016/S0140-6736(09)60692-9. Epub 2009 Apr 6. PMID: 19356795.
- ↑ Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet. 2006 Sep 16;368(9540):1005-11. doi: 10.1016/S0140-6736(06)69208-8. PMID: 16980116.
- ↑ 4.0 4.1 Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL; et al. (1999). "Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study)". Am J Cardiol. 83 (6): 897–902. PMID 10190406.
- ↑ Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL; et al. (1999). "Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study)". Am J Cardiol. 83 (6): 897–902. PMID 10190406.
- ↑ 6.0 6.1 Gaasch WH, Meyer TE. Left ventricular response to mitral regurgitation: implications for management. Circulation. 2008 Nov 25;118(22):2298-303. doi: 10.1161/CIRCULATIONAHA.107.755942. PMID: 19029478.
- ↑ 7.0 7.1 7.2 Avierinos JF, Inamo J, Grigioni F, Gersh B, Shub C, Enriquez-Sarano M. Sex differences in morphology and outcomes of mitral valve prolapse. Ann Intern Med. 2008 Dec 2;149(11):787-95. doi: 10.7326/0003-4819-149-11-200812020-00003. PMID: 19047025; PMCID: PMC2897166.
- ↑ Abadie BQ, Cremer PC, Vakamudi S, Gillinov AM, Svensson LG, Cho L. Sex-Specific Prognosis of Left Ventricular Size and Function Following Repair of Degenerative Mitral Regurgitation. J Am Coll Cardiol. 2024 Jan 16;83(2):303-312. doi: 10.1016/j.jacc.2023.10.033. PMID: 38199708.
- ↑ Watt TMF, Brescia AA, Murray SL, Burn DA, Wisniewski A, Romano MA, Bolling SF; Michigan Mitral Research Group (MMRG). Degenerative Mitral Valve Repair Restores Life Expectancy. Ann Thorac Surg. 2020 Mar;109(3):794-801. doi: 10.1016/j.athoracsur.2019.07.014. Epub 2019 Aug 28. PMID: 31472142; PMCID: PMC7377922.