Prevalence and cardiovascular phenotypes of dextrocardia and situs inversus among 277,396 adults: longitudinal evidence of amplified age-related blood pressure progression.

Abstract

Background: Dextrocardia and situs inversus are rare congenital malformations. Although associated anomalies are well recognized, their prevalence in unselected adult populations and their cardiovascular phenotypes, particularly blood pressure in nonclinical settings, remain poorly characterized. This study aimed to estimate their prevalence, blood pressure profiles, and longitudinal changes in a large nonclinical cohort.

Methods: In this longitudinal observational study, we reviewed records from the Beijing MJ health check-up cohort (2003-2025). Dextrocardia and situs inversus were confirmed via electrocardiography and imaging. Linear regression models assessed blood pressure differences, adjusting for age, sex, body mass index, glucolipid metabolism, renal function, and lifestyle factors. Linear mixed-effects models evaluated long-term blood pressure changes.

Results: Among 277,396 adults, 43 had dextrocardia, 38 had situs inversus, and 29 had both. The prevalence (95% CI) was 1.6 (1.1-2.0) per 10,000 for dextrocardia and 1.4 (0.9-1.8) per 10,000 for situs inversus. In fully adjusted models, dextrocardia was associated with a 5.3 mmHg higher SBP (95% CI: 1.3-9.2) and a 4.5 mmHg higher DBP (1.7-7.4). Situs inversus was associated with a 7.0 mmHg higher SBP (2.8-11.2) and a 3.3 mmHg higher DBP (0.3-6.3). Longitudinally, each 10-year increase in age was associated with an additional 5.9 mmHg rise in SBP in dextrocardia (1.0-10.7; P for interaction = 0.02) and 5.5 mmHg in situs inversus (0.5-10.6; P for interaction = 0.03) compared with controls.

Conclusion: In this large nonclinical cohort, dextrocardia and situs inversus were associated with higher blood pressure and a steeper age-related increase in SBP. Further studies are needed to confirm these findings.