CLINICAL STUDY
Mitral valve prolapse in the general population
the benign nature of echocardiographic features in the Framingham Heart Study
Lisa A. Freed, MD, FACC*  ,
Emelia J. Benjamin, MD, ScM, FACC* ||,
Daniel Levy, MD, FACC*||¶#,
Martin G. Larson, ScD*||,
Jane C. Evans, DSc*||,
Deborah L. Fuller, RDCS*,
Birgitta Lehman, RDCS* and
Robert A. Levine, MD, FACC,*
* National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts, USA
Cardiac Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
Harvard Medical School, Boston, Massachusetts, USA
Cardiology, Boston University School of Medicine, Boston, Massachusetts, USA
|| Epidemiology and Preventive Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
¶ National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
# Divisions of Cardiology and Clinical Epidemiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
Manuscript received October 15, 2001;
revised manuscript received May 30, 2002,
accepted July 2, 2002.
* Reprint requests and correspondence: Dr. Robert A. Levine, Massachusetts General Hospital, Cardiac Ultrasound Laboratory, 55 Fruit Street-VBK 508, Boston, Massachusetts 02114, USA.
rlevine{at}partners.org
OBJECTIVES: The aim of this study was to examine the echocardiographic features and associations of mitral valve prolapse (MVP) diagnosed by current two-dimensional echocardiographic criteria in an unselected outpatient sample.
BACKGROUND: Previous studies of patients with MVP have emphasized the frequent occurrence of echocardiographic abnormalities such as significant mitral regurgitation (MR) and left atrial (LA) enlargement that are associated with clinical complications. These studies, however, have been limited by the use of hospital-based or referral series.
METHODS: We quantitatively studied all 150 subjects with possible MVP by echocardiography and 150 age- and gender-matched subjects without MVP from the 3,491 subjects in the Framingham Heart Study. Based on leaflet morphology, subjects were classified as having classic (n = 46), nonclassic (n = 37), or no MVP.
RESULTS: Leaflet length, MR degree, and LA and left ventricular size were significantly but mildly increased in MVP (p < 0.0001 to 0.004), with mean values typically within normal range. Average MR jet area was 15.1 ± 1.4% (mild) in classic MVP and 8.9 ± 1.5% (trace) in nonclassic MVP; MR was severe in only 3 of 46 (6.5%) subjects with classic MVP, and LA volume was increased in only 8.7% of those with classic MVP and 2.7% of those with nonclassic MVP.
CONCLUSIONS: Although the echocardiographic characteristics of subjects with MVP in the Framingham Heart Study differ from those without MVP, they display a far more benign profile of associated valvular, atrial, and ventricular abnormalities than previously reported in hospital- or referral-based series. Therefore, these findings may influence the perception of and approach to the outpatient with MVP.
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Abbreviations and Acronyms
| | 2-D | | two-dimensional | | LA | | left atrial/atrium | | LV | | left ventricle/ventricular | | LVIDd | | left ventricular internal diameter in end-diastole | | LVIDs | | left ventricular internal diameter in end-systole | | MR | | mitral regurgitation | | MVP | | mitral valve prolapse |
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