Prevalence of valvular regurgitation by Doppler echocardiography in patients with structurally normal hearts by two-dimensional echocardiography

Choong, C.; Abascal, Vivian M.; Weyman, Jean; Levine, Robert A.; Gentile, Francesco; Thomas, James D.; Weyman, Arthur E.

doi:10.1016/0002-8703(89)90739-4

Cited by 184 publications

(84 citation statements)

References 7 publications

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“…In our study these valvular regurgitations were not more prevalent among patients than among controls. Additionally, the prevalence of these regurgitations in our control group was consistent with the reported prevalence of regurgitations in agematched subjects with structurally normal hearts (27).…”

Section: Discussionsupporting

confidence: 90%

No increased risk of valvular heart disease in adult poststreptococcal reactive arthritis

Bemmel

Delgado

Holman

et al. 2009

Arthritis & Rheumatism

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Objective. Poststreptococcal reactive arthritis (ReA) is a (poly)arthritis presenting after a Streptococcus group A infection. Acute rheumatic fever (ARF), albeit caused by the same pathogen, has different risk characteristics and is considered to be a separate entity. Whereas ARF is known to cause carditis, the risk of carditis in adult poststreptococcal ReA is unknown. Consequently, the prevailing recommendations regarding long-term antibiotic prophylaxis in poststreptococcal ReA are imprecise and derived from the data on ARF. This study was undertaken to investigate the development of valvular heart disease in an unselected cohort of adult patients with poststreptococcal ReA who did not receive antibiotic prophylaxis and were followed up prospectively.Methods. All patients presenting with early arthritis to an inception cohort of >2,000 white patients were evaluated. Patients presenting with poststreptococcal ReA (n ‫؍‬ 75) were selected. After a median followup of 8.9 years, the occurrence of valvular heart disease was evaluated by transthoracic echocardiography in 60 patients. Controls were matched for age, sex, body surface area, and left ventricular function, with a patient-tocontrol ratio of 1:2.Results. No differences were seen in left ventricular dimensions. Morphologic abnormalities of the mitral or aortic valves were not more prevalent among patients than among controls. Mild mitral regurgitation was present in 23% and 21% of patients and controls, respectively. Mild aortic regurgitation was present in 10% and 11%, and mild tricuspid regurgitation in 43% and 39%, respectively, revealing no significant differences.Conclusion. Our findings indicate that there is no increased risk of valvular heart disease in adult poststreptococcal ReA. Based on these data, routine longterm antibiotic prophylaxis is not recommended in adult poststreptococcal ReA.

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Section: Discussionsupporting

confidence: 90%

No increased risk of valvular heart disease in adult poststreptococcal reactive arthritis

Bemmel

Delgado

Holman

et al. 2009

Arthritis & Rheumatism

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“…A higher prevalence of minor valve regurgitation in older persons has been shown in previous population-based studies 14,15 and in the study of Khan et al 8 Age emerged in the present study as an independent predictor of FDA-grade regurgitation, even …”

Section: Discussionsupporting

confidence: 77%

Prevalence and Determinants of Valvulopathy in Patients Treated With Dexfenfluramine

et al. 1999

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Background-Valve regurgitation has been associated with dexfenfluramine, but its prevalence and severity are uncertain.Additional factors that may contribute to valve regurgitation in patients exposed to this drug are poorly understood. Methods and Results-Echocardiography was performed on subjects recruited from 26 prescribing sites in 15 states. The total sample of 412 subjects included 172 dexfenfluramine patients and 172 unexposed controls matched for age, sex, and body mass index and 68 unmatched subjects meeting the same entry criteria (51 dexfenfluramine patients and 17 controls). Mean treatment duration was 6.9 months; mean interval from treatment discontinuation to echocardiogram was 8.5 months. Each echocardiogram was interpreted independently by 3 echocardiographers. FDA-grade regurgitation (at least mild aortic regurgitation or at least moderate mitral regurgitation) was significantly more frequent in dexfenfluramine patients (7.6% versus 2.1% for controls; Pϭ0.01; odds ratio, 3.82). This difference was primarily due to more frequent mild aortic regurgitation in dexfenfluramine patients (6.3% versus 1.6% in controls; PϽ0.02; odds ratio, 4.15). No differences were found in sclerosis or mobility for either the aortic or mitral valve. Factors independently related to FDA-grade regurgitation or any grade of aortic regurgitation were older age, higher diastolic blood pressure at the time of echocardiography, and shorter time from drug discontinuation to echocardiogram. Conclusions-Dexfenfluramine use is associated with an increase in the prevalence of abnormal valve regurgitation. Age and blood pressure may also affect the prevalence of regurgitation. Dexfenfluramine-related valve regurgitation may regress after drug discontinuation. (Circulation. 1999;100:2161-2167.)

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“…Small tricuspid regurgitations such as the one displayed in Fig. 5b are commonly observed with Doppler flow imaging in patients with structurally normal hearts (39). Location (ii) is in both the outflow and inflow paths of the LV, which are plainly pictured as upward (black) and downward (white) flows in Fig.…”

Section: Fig 5 Amentioning

confidence: 94%

High temporal resolution phase contrast MRI with multiecho acquisitions†

Thompson

McVeigh

2002

Magnetic Resonance in Med

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Velocity imaging with phase contrast (PC) MRI is a noninvasive tool for quantitative blood flow measurement in vivo. A shortcoming of conventional PC imaging is the reduction in temporal resolution as compared to the corresponding magnitude imaging. For the measurement of velocity in a single direction, the temporal resolution is halved because one must acquire two differentially flow-encoded images for every PC image frame to subtract out non-velocity-related image phase information. In this study, a high temporal resolution PC technique which retains both the spatial resolution and breath-hold length of conventional magnitude imaging is presented. Improvement by a factor of 2 in the temporal resolution was achieved by acquiring the differentially flow-encoded images in separate breath-holds rather than interleaved within a single breath-hold. Additionally, a multiecho readout was incorporated into the PC experiment to acquire more views per unit time than is possible with the single gradient-echo technique. A total improvement in temporal resolution by ϳ5 times over conventional PC imaging was achieved. A complete set of images containing velocity data in all three directions was acquired in four breath-holds, with a temporal resolution of 11.2 ms and an inplane spatial resolution of 2 mm ؋ 2 mm. Magn Reson Med 47: 499 -512,

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Prevalence of valvular regurgitation by Doppler echocardiography in patients with structurally normal hearts by two-dimensional echocardiography

Cited by 184 publications

References 7 publications

No increased risk of valvular heart disease in adult poststreptococcal reactive arthritis

No increased risk of valvular heart disease in adult poststreptococcal reactive arthritis

Prevalence and Determinants of Valvulopathy in Patients Treated With Dexfenfluramine

High temporal resolution phase contrast MRI with multiecho acquisitions†

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