First report on the epidemiology and clinical features of multiple valvular heart disease in a middle eastern cohort

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Abstract Background Multiple valvular heart disease (MVD), defined as moderate or severe disease affecting ≥2 valves, is underrepresented in international guidelines and its epidemiology in the Middle East is not well characterized. This study aimed to determine the prevalence and clinical characteristics of significant MVD in a large Middle Eastern tertiary care center. Methods We retrospectively reviewed all transthoracic echocardiograms performed at a large tertiary care center from January 1, 2024–December 31, 2024, in adults ≥18 years with Grade I or greater valve disease. From this cohort, we identified and analyzed patients with moderate, moderate-to-severe, or severe disease involving ≥2 valves (MVD) and characterized their clinical and echocardiographic features. Results Of 16,101 patients with Grade I or greater valve disease, 2,955 (18.3%) had moderate or moderate-to-severe or severe disease in ≥1 valve. Among these, tricuspid regurgitation (TR) was the most common lesion (1,458, 49%), followed by mitral regurgitation (MR) (929, 31%) and aortic stenosis (AS) (410, 14%). Of the 2,955 patients, 565 (19%) had MVD. The MVD cohort was predominantly female (57%), with mean age 57 ± 18 years. Left ventricular systolic dysfunction was common, with median ejection fraction of 42.5% (IQR 27.0-55.0%). Rheumatic etiology accounted for 18% of cases with the remaining 78% due to other causes. Concurrent atrial fibrillation occurred in 18%. Two-valve involvement was most frequent (n=505, 89.4%), followed by three-valve (n=53, 9.4%) and four-valve disease (n=7, 1.2%). Mitral and tricuspid valve combinations dominated the MVD phenotypes, with MR-TR being most prevalent (239 patients, 42.3%), followed by MS-TR (54, 9.6%), TR-PR (50, 8.8%), AS-TR (37, 6.5%), AR-MR (28, 5.0%), AS-MS (21, 3.7%), and AS-MR (15, 2.7%). Conclusions This is the first study to characterize MVD prevalence and characteristics in the Middle East, demonstrating that 19% of patients with moderate or greater valve disease have multiple valve involvement. MVD predominantly affected females and is frequently associated with atrial fibrillation. Further clinical characteristics, long-term outcomes and prognostic implications of this MVD cohort are under investigation.For image description, please refer to the figure legend and surrounding text.

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