Pulmonic regurgitation epidemiology and demographics
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Pulmonic regurgitation Microchapters |
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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]
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 increase with age. 24% of 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]
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]
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).[7] The multitude of causes makes the determination of exact prevalence of PR difficult.[8]
- 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.[9]
- 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 found to increase with age.[10]
Race
- There is no racial or ethnic predilection for pulmonary regurgitation.
Gender
- In 2017, Pulmonic regurgitation (PR) was found to be more prevalent among Tibetan women.[10]
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).[11] 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.[12][13]
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.[12][14]
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.
- ↑ 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.
- ↑ 10.0 10.1 Yang Y, Chen YD, Feng B, Ji ZX, Mao W, Zhi G (October 2017). "Factors Related to Ventricular Size and Valvular Regurgitation in Healthy Tibetans in Lhasa". Chin. Med. J. 130 (19): 2316–2320. doi:10.4103/0366-6999.215327. PMC 5634082. PMID 28937038.
- ↑ "Pulmonary Hypertension | NHLBI, NIH".
- ↑ 12.0 12.1 Bhagavatula SK, Idrees MM (July 2014). "Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Challenges in managing pulmonary hypertension in the developing countries". Ann Thorac Med. 9 (Suppl 1): S127–30. doi:10.4103/1817-1737.134059. PMC 4114281. PMID 25076991.
- ↑ 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.