Evaluation of Mitral and Aortic Valvular Disease and Left Ventricular Dysfunction in a Lebanese Population: Retrospective Single-Center Experience

Abstract

Background Recently, new therapeutic approaches have revolutionized the management of left ventricular dysfunction (LVD) and valvular heart disease (VHD), which are a growing public health problem. In parallel, there are no available epidemiological data about LVD and VHD in developing countries, especially in the Mediterranean area. This retrospective study was conducted at a single center and aimed to evaluate the associations between mitral and aortic valvular disease and left ventricle systolic and diastolic dysfunction in the Lebanese population. Material/Methods A retrospective study was conducted of 4520 consecutive patients aged >18 years who were referred to the Cardiovascular Department of Notre Dame de Secours-University Hospital in Jbeil-Lebanon for transthoracic echocardiography between December 2016 and December 2019. The study population was divided into different groups based on types of LVD and VHD. Left ventricle systolic dysfunction was defined as a left ventricle ejection fraction (EF) ≤40%. Statistical analysis was carried out using SPSS software version 20. Results VHD and systolic dysfunction were more common in men, whereas diastolic dysfunction was more common in women. Being older than age 65 years and smoking were significantly associated with heart failure with preserved EF, whereas female sex was a significant preventive factor against heart failure with reduced EF. Systemic hypertension was correlated with mitral stenosis and tricuspid regurgitation, whereas diabetes mellitus was associated with tricuspid regurgitation (TR). Smoking and older age also appeared to be associated with aortic stenosis. Conclusions Mitral valve disease (regurgitation and stenosis) was significantly correlated with systolic dysfunction, whereas aortic and mitral regurgitation were associated with diastolic dysfunction. Better monitoring of cardiovascular disease risk factors may lead to a reduced burden of LVD and VHD.

Different heart failure phenotypes of valvular heart disease: the role of mitochondrial dysfunction

“…The most prominent feature of HFpEF is DD, which can be caused by both MS and MR, suggesting that patients with MS and/or MR may suffer from HFpEF. MS significantly increases the risk of LV DD and mostly develops in elderly patients and/or in patients with hypertension, which is consistent with the etiological features of HFpEF (12). LAF is the critical pathophysiological process in the early stage of HFpEF in MS patients.…”

“…Abdurashidova et al (77) recently showed that even mild AR was associated with a two-fold increase risk on short-term all-cause mortality in HFpEF patients. Inconsistent with the above findings, Nader et al (12) reported that AR was a protective factor for the development of DD among VHD patients in the Lebanese population, which may be related to study selection bias.…”

“…Mitral valve damages increases the risk of HFrEF. A recent study on evaluating the associations of cardiac valve damages in a Lebanese population with myocardial function reported that mitral valve diseases were associated with a 6.2-fold increased risk of left ventricular (LV) SD but exhibited heterogeneity with different types of valvular damages (12). Mitral regurgitation (MR) alters contractility by inducing LV remodeling, while mitral stenosis (MS) directly reduces LV strain and contractility.…”

“…MR also increases the risk of HFpEF. In the Lebanese population, Nader et al (12) found that MR increased the risk of LV DD, even in MR patients who did not have HF symptoms, but still had a probability of progression to HFpEF. MR patients with LV DD often suffer from hypertension, coronary artery disease, and diabetes mellitus, consistent with the etiological characteristics of HFpEF (62).…”