Epidemiologic Profile of Patients With Valvular Heart Disease in Korea: A Nationwide Hospital-Based Registry Study

Abstract

Background: Valvular heart disease (VHD) is a common cause of cardiovascular morbidity and mortality worldwide; however, its epidemiological profile in Korea requires elucidation.

Methods: In this nationwide retrospective cohort study from the Korean valve survey, which collected clinical and echocardiographic data on VHD from 45 medical centers, we identified 4,089 patients with VHD between September and October 2019.

Results: The aortic valve was the most commonly affected valve (n = 1,956 [47.8%]), followed by the mitral valve (n = 1,598 [39.1%]) and tricuspid valve (n = 1,172 [28.6%]). There were 1,188 cases of aortic stenosis (AS) and 926 cases of aortic regurgitation. The most common etiology of AS was degenerative disease (78.9%). The proportion of AS increased with age and accounted for the largest proportion of VHD in patients aged 80-89 years. There were 1,384 cases of mitral regurgitation (MR) and 244 cases of mitral stenosis (MS). The most common etiologies for primary and secondary MR were degenerative disease (44.3%) and non-ischemic heart disease (63.0%), respectively, whereas rheumatic disease (74.6%) was the predominant cause of MS. There were 1,172 tricuspid regurgitation (TR) cases, of which 46.9% were isolated and 53.1% were associated with other valvular diseases, most commonly with MR. The most common type of TR was secondary (90.2%), while primary accounted for 6.1%.

Conclusions: This report demonstrates the current epidemiological status of VHD in Korea. The results of this study can be used as fundamental data for developing Korean guidelines for VHD.

Keywords: Epidemiology; Korea; Valvular heart diseases.

Figure 1. Echocardiographic images of valvular heart disease. Degenerative calcific aortic stenosis is shown on a mid-esophageal aortic valve short-axis view on transesophageal echocardiography (A); rheumatic mitral stenosis is shown on the parasternal short-axis view aortic level on transthoracic echocardiography (B); aortic regurgitation detected on color Doppler in the parasternal long-axis view on transthoracic echocardiography (C); mitral valve posterior prolapse with significant mitral regurgitation on 2-dimensional (D) and color Doppler (E) in the mid-esophageal 2-chamber view on transesophageal echocardiography; and failure of tricuspid valve coaptation during systole (F) and significant tricuspid regurgitation on color Doppler (G) in the apical 4-chamber view on transthoracic echocardiography.

Figure 2. Distribution of valvular heart disease in men and women by age.

AR: aortic regurgitation, AS: aortic stenosis, MR: mitral regurgitation, MS: mitral stenosis, TR: tricuspid regurgitation.

Figure 3. Proportion of age group by valvular heart disease type.

AR: aortic regurgitation, AS: aortic stenosis, LV: left ventricular, MR: mitral regurgitation, MS: mitral stenosis, TR: tricuspid regurgitation.

Figure 4. Etiology of each valvular heart disease. Pie charts showing the distribution of the etiology of mitral stenosis (A), primary mitral regurgitation (B), secondary mitral regurgitation (C), aortic stenosis (D), aortic regurgitation (E), and tricuspid regurgitation (F) in Korea.