Association of Valvular Disease Progression Using Echocardiographic Findings in a Large U.S. Cohort

ABSTRACT Background The prevalence of valvular disease in the US is approximately 2.5%. Given that over 5 million Americans are affected, it is crucial to find those at higher risk of progression. The goal of this paper is to uncover which patients are more likely to have valvular disease progression using demographic factors, EKG and echocardiogram (ECHO) findings. Methods This paper utilized the EchoNext Database, which pairs 100,000 electrocardiograms and echocardiograms based on specific structural heart disease labels. Univariate and multivariate logistic regression were used to find risk factors for progression for aortic stenosis (AS), aortic regurgitation (AR), mitral regurgitation (MR), tricuspid regurgitation (TR) and pulmonary insufficiency (PI). Progression was defined as worsened valvular disease on follow up ECHOs. Results There were 100,000 encounters of EKGs/ECHOs included in the study, and 36,286 individual patients. Independent risk factors of AS progression were age and QRS duration. Age, QRS duration, AS, AR, MR and pericardial effusion were independent risk factors for AR progression. MR progression was independently associated with PR, QRS and QTc durations, MR and left ventricular ejection fraction. QRS duration, MR, TR and right ventricular function were independent factors for TR progression. Lastly, for PI progression, male sex and AS were found to be independent risk factors. Conclusions The combination of demographic, electrocardiographic and echocardiographic findings can help better assess the progression of valvular disease.