Although our finding of tricuspid regurgitation in 68 percent of our patients is somewhat less than the 80 percent to 90 percent reported in detailed research studies performed for evaluation of right-sided cardiac pressures, the prevalence reported in this study is similar to that reported in several studies of “normal” volunteers but considerably higher than that reported from another clinical practice not routinely using color-Doppler evaluation.
The relationship between age and the prevalence of aortic regurgitation supports data reported by others. The lack of relationship between age and the prevalence of either mitral or tricuspid regurgitation is probably related to the very high prevalence of valvular regurgitation detected by these multiple Doppler modalities in younger subjects. The severity of mitral and tricuspid regurgitation, however, was related to age. These data regarding age are potentially clinically significant, since recent data demonstrated a strong age bias in the provision of endocarditis prophylaxis recommendations.
There are several limitations to the present report that should be emphasized. Our study was retrospective and included patients referred for Doppler echocardiographic evaluation for some suspected cardiac abnormality. Although these patients had normal 2D and M-mode echocardiograms, they all may not have necessarily had “normal” hearts. In this study cohort, therefore, a somewhat higher prevalence of valvular regurgitation would be suspected than that found in “normal” volunteers. However, the prevalence of valvular regurgitation in the present study is only slightly higher than that reported with only color-Doppler evaluation of “normal” volunteers. In addition, the patients referred to our echocardiographic laboratory are likely to be similar to those referred to other major clinical laboratories. The fact that this study was retrospective and the data were collected during a very busy clinical practice probably would lead to an underestimation of the “true” prevalence of valvular regurgitation; however, even in a busy clinical laboratory, a very high prevalence of valvular regurgitation can be detected with modern technology, and quite often right-sided cardiac pressures can be estimated.