Natural history of asymptomatic mitral valve prolapse in the community

• Published in: Circulation (New York, N.Y.) Vol. 106; no. 11; pp. 1355 - 1361
• Main Authors: AVIERINOS, Jean-Francois, GERSH, Bernard J, MELTON, L. Joseph, BAILEY, Kent R, SHUB, Clarence, NISHIMURA, Rick A, TAJIK, A. Jamil, ENRIQUEZ-SARANO, Maurice
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 10-09-2002; American Heart Association, Inc
• Subjects: Aged; Biological and medical sciences; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Cardiovascular system; Disease-Free Survival; Female; Follow-Up Studies; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Mitral Valve Prolapse - complications; Mitral Valve Prolapse - diagnosis; Mitral Valve Prolapse - diagnostic imaging; Mitral Valve Prolapse - mortality; Prognosis; Risk Factors; Survival Rate; Ultrasonic investigative techniques; Ultrasonography; Sonography; Human; Mitral valve; Echocardiography; Prognosis; Pathophysiology; Mortality; Cardiovascular disease; Exploration; Asymptomatic; Morbidity; Prolapsus; Cardiac valvular disease; Diagnosis
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.0000028933.34260.09

The outcome of mitral valve prolapse (MVP) is controversial, with marked discrepancies in reported complication rates.
We conducted a community study of all Olmsted County, Minn, residents first diagnosed with asymptomatic MVP between 1989 and 1998 (N=833). Diagnosis, motivated by auscultatory findings (n=557) or incidental (n=276), was always confirmed by echocardiography with the use of current criteria. End points analyzed during 4581 person-years of follow-up were mortality (n=96, 19+/-2% at 10 years), cardiovascular morbidity (n=171), and MVP-related events (n=109, 20+/-2% at 10 years). The most frequent primary risk factors for cardiovascular mortality were mitral regurgitation from moderate to severe (P=0.002, n=131) and, less frequently, ejection fraction <50% (P=0.003, n=31). Secondary risk factors independently predictive of cardiovascular morbidity were slight mitral regurgitation, left atrium > or =40 mm, flail leaflet, atrial fibrillation, and age > or =50 years (all P<0.01). Patients with only 0 or 1 secondary risk factor (n=430) had excellent outcome, with 10-year mortality of 5+/-2% (P=0.17 versus expected), cardiovascular morbidity of 0.5%/y, and MVP-related events of 0.2%/y. Patients with > or =2 secondary risk factors (n=250) had mortality similar to expected (P=0.20) but high cardiovascular morbidity (6.2%/y, P<0.01) and notable MVP-related events (1.7%/y, P<0.01). Patients with primary risk factors (n=153) showed excess 10-year mortality (45+/-9%, P=0.01 versus expected), high morbidity (18.5%/y, P<0.01), and high MVP-related events (15%/y, P<0.01).
Natural history of asymptomatic MVP in the community is widely heterogeneous and may be severe. Clinical and echocardiographic characteristics allow separation of the majority of patients with excellent prognosis from subsets of patients displaying, during follow-up, high morbidity or even excess mortality as direct a consequence of MVP.