Echocardiography detection rate of newly diagnosed valvular heart disease amongst patients 12 years old and beyond, referred for transthoracic echocardiography in tertiary care settings

Abstract

Introduction: Valvular heart disease (VHD) is a significant contributor to cardiovascular morbidity and mortality. Despite global awareness, data on the epidemiology and clinical profile of VHD in Malaysia remain limited. This study aimed to determine the echocardiographic detection rate of newly diagnosed VHD in tertiary care centres in Perak, Malaysia, as well as to examine its clinical characteristics, aetiologies, severity, associated comorbidities, and the rate of patient acceptance for valve intervention.

Materials and methods: A retrospective, multi-center study was conducted involving patients who underwent echocardiography over a six-month period. The data were then analysed to address the study objectives. Statistical analysis was performed using SPSS version 25.0.

Results: Of the 12,610 patients who underwent echocardiography, 946 were newly diagnosed with VHD, yielding a detection rate of 7.5%. The median age of VHD patients was 67 years, with a slight female predominance. The median left ventricular ejection fraction (LVEF) was 57%. Approximately 66% of patients were symptomatic, with dyspnoea being the most common symptom (46.85%). Pulmonary hypertension was observed in 35.3% of patients. Atrial fibrillation (AF) was present in 12.2% of cases. Mitral regurgitation (MR) was the most common valve lesion (34.1%), followed by tricuspid regurgitation (TR, 32.3%) and aortic regurgitation (AR, 19.2%). Functional aetiology was the most frequent cause of VHD, accounting for 59%. Rheumatic heart disease (RHD) was responsible for 51.7% of mitral stenosis (MS) cases, while degenerative causes predominated in AR (74.9%), aortic stenosis (AS) (84.6%), and primary MR (71.4%). The majority of VHD cases were mild (65.6%), with 29.2% moderate and 5.1% severe. Among VHD patients, 34.7% had clinically significant moderate or severe disease. In this subgroup, the predominant aetiologies were functional for MR (52.1%), TR (96.7%), and pulmonary regurgitation (PR, 100%), while degenerative causes were prevalent in AR (63.6%) and AS (84.3%), and RHD was the leading cause of MS (57.1%). Multiple valve involvement was observed in 72.6% of cases. Two-valve involvement accounted for 52.5%, with MR and TR being the most common combination (68.7%), mainly due to functional causes. AS was significantly associated with hypertension and dyslipidaemia. MR showed strong associations with AF, chronic kidney disease (CKD), and ischemic heart disease (IHD), while TR was more common in females. Despite 6.7% of patients requiring valve intervention, only 24.2% consented. A total of 36.4% declined intervention, primarily due to concerns about advanced age (62.5%) and fear of surgery (29.2%), while 39.4% remained undecided.

Conclusion: The echocardiographic detection rate of newly diagnosed VHD was 7.5%, with functional MR being the most common lesion (20.7%). The majority of patients refused valve intervention, primarily due to old age. This study provides valuable insight into the burden and management challenges of VHD in Malaysia.