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Mitral regurgitation epidemiology and demographics

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

  1. ↑ 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. ↑ 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.
  3. ↑ 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. ↑ 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.
  5. ↑ 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. ↑ 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. ↑ 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.
  8. ↑ 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.
  9. ↑ 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.

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