Prevalence and Clinical Determinants of Severe Multivalvular Heart Disease: The Bronx-Valve Registry

Valvular heart disease (VHD) is increasingly prevalent and associated with substantial morbidity and mortality. However, severe multivalvular heart disease (MVHD) remains poorly characterized; therefore, we sought to elucidate its prevalence, phenotypes, and clinical correlates. A single center study including all individuals with echocardiographic diagnosis of native VHD between 2010 and 2019 were included and grouped by the presence of severe MVHD. Multivariable logistic regression was used to determine the association between clinical and echocardiographic factors and presence of severe MVHD. A total of 95,588 patients (age 67 ± 16.4; female 57.1%) comprised the study cohort. Severe VHD was diagnosed in 7,499 (7.8%) patients: 87.7% with severe single VHD and 12.3% with severe MVHD. Among those with severe MVHD, mitral-tricuspid was the most prevalent valve combination (68.4%), followed by aortic-mitral (13.7%), and aortic-tricuspid (11.9%). According to MVHD type, mitral regurgitation, and tricuspid regurgitation was the most prevalent combination (70.6%), followed by aortic stenosis and tricuspid regurgitation (11.1%), and aortic stenosis and mitral regurgitation (7.6%). Severe MVHD was associated with older age (odds ratio [OR] 1.04 [1.03 to 1.05]), lower body surface area (OR 0.18 [0.08 to 0.41]), atrial fibrillation (1.92 [1.31 to 2.81]), chronic kidney disease (OR 2.08 [1.40 to 3.09]), rheumatic heart disease (OR 2.06 [1.23 to 3.45]), absence of hyperlipidemia (OR 0.41 [0.27 to 0.62]), larger left ventricular (LV) end-diastolic dimension (OR1.60 [1.26 to 2.03]), lateral E/e' (OR 1.03 [1.02 to 1.05]), and lower LV ejection fraction (OR 0.95 [0.94 to 0.96]). In conclusion, approximately 12% of patients with severe VHD had MVHD, most commonly involving the mitral and tricuspid valves, followed by aortic-mitral, and then aortic-tricuspid.